S1838 Usefulness of a Large Set of Tests for the Diagnosis of Hepatic Encephalopathy

Abstract

In patients with liver cirrhosis, minimal hepatic encephalopathy (MHE) is associated with a poor quality of life and difficulty in driving. It has also been suggested that MHE can precede the development of overt hepatic encephalopathy (OHE). No gold standard exists to detect MHE. Therefore the prevalence of this entity varies depending on the diagnostic methods used. Aims & Methods: To assess: a) the prevalence of MHE using standard (1) and nonstandard diagnostic methods, b) the usefulness of these tests for predicting of OHE, 51 patients with liver cirrhosis and portal hypertension (29 with primary biliary cirrhosis, 22 with HCV infection) were studied. In all patients we performed seven diagnostic tests: four psychometric tests (NTC-A, NTC-B, DST, BDT), EEG, spectral EEG, P300 auditory event related potential, critical flicker frequency (CFF), proton magnetic resonance spectroscopy of the brain (1HMRS) and serum concentration of astroglial protein S100β.Patients were followed up for a period of 4 years. Results: Based on the psychometric tests, 9 out of 51 patients (17.6%, 95% CI 7-28) were diagnosed to have MHE. If the results of EEG, P300 and spectral EEG were added, the prevalence of MHE raised to 16 of 51 patients (31.3%, 95% CI 18-44). Addition one nonstandard test (CFF, 1HMRS or S100β) raised the percentage of patients suspected of MHE to above 40%. During follow up OHE developed in 14 patients but MHE in this group was earlier diagnosed using psychometric tests in only 10 patients. Twelve of 14 patients with OHE had at least one abnormal result out of the seven tests. Multiple proportional hazard regression model showed a higher risk of OHE in patients with abnormal EEG (HR 8.4, 95% CI 2.6 -27.3, p < 0.001). Other factors, including psychometric and standard and nonstandard tests, did not predict the OHE. Conclusions: 1. Diagnosis of minimal hepatic encephalopathy needs further standardization. 2. Among the seven different diagnostic methods, only EEG has a predicting value for overt hepatic encephalopathy in cirrhotic patients. Reference: 1.Ferenci P.et al: Hepatology.2002;35:716 Supported by grant MNiSzW 3PO5B03926