Stepwise diagnosis in covert hepatic encephalopathy: critical flicker frequency and MELD‐score as a first‐step approach

R. Greinert; C. Ripoll; M. Hollenbach; A. Zipprich

doi:10.1111/apt.13721

journal article Jul 07, 2016

Stepwise diagnosis in covert hepatic encephalopathy: critical flicker frequency and MELD‐score as a first‐step approach

R. Greinert C. Ripoll M. Hollenbach A. Zipprich

Alimentary Pharmacology & Therapeutics Vol. 44 No. 5 pp. 514-521 · Wiley

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Abstract

SummaryBackgroundThe diagnosis of covert hepatic encephalopathy (CHE) by means of portosystemic encephalopathy syndrome (PSE) test is costly and therefore infrequently performed.AimTo determine the ability of critical flicker frequency (CFF) alone or in combination with laboratory findings, as an initial test to pre‐select which patients should undergo further testing for the diagnosis of covert hepatic encephalopathy.MethodsThis single‐centre study included all patients with cirrhosis who underwent PSE and CFF in 2011. CHE was defined by abnormal PSE test. Logistic regression analysis was performed to identify predictors of CHE. ROC curves were used to identify cut‐offs of these independent predictors.ResultsOne hundred and seventeen patients were included. Seventy (60%) had CHE with a higher MELD [16 (IQR 13–21); P = 0.001] and lower CFF [38 Hz (IQR 36–41) P = 0.0011]. On multivariate analyses, CFF [OR 0.83 (95% CI 0.74–0.94)] and MELD [OR 1.13 (95% CI 1.04–1.22)] were identified as independent predictors of CHE. Sensitivity and specificity of a CFF cut‐off of 43 Hz was 93.5% and 42.9%, and for a MELD cut‐off of 24, it was 97.5% and 32.8% respectively. Most patients with a MELD‐Score <24 and a CFF >43 Hz did not have CHE (78%) and with a MELD‐Score >24 and CFF <43 Hz most patients had CHE (85%). Therefore, 27% of patients could avoid further testing with a diagnostic accuracy of 81%.ConclusionThe combination of MELD‐score and critical flicker frequency may be used as a first diagnostic step to filter patients, in whom further covert hepatic encephalopathy testing could be avoided.

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Details

Published: Jul 07, 2016
Vol/Issue: 44(5)
Pages: 514-521
License: View

Authors

R

R. Greinert

Department of Internal Medicine I Martin‐Luther‐University Halle‐Wittenberg Halle Germany

C

C. Ripoll

Department of Internal Medicine I Martin‐Luther‐University Halle‐Wittenberg Halle Germany

M

M. Hollenbach

Department of Internal Medicine I Martin‐Luther‐University Halle‐Wittenberg Halle Germany

A

A. Zipprich

Department of Internal Medicine I Martin‐Luther‐University Halle‐Wittenberg Halle Germany

Cite This Article

R. Greinert, C. Ripoll, M. Hollenbach, et al. (2016). Stepwise diagnosis in covert hepatic encephalopathy: critical flicker frequency and MELD‐score as a first‐step approach. Alimentary Pharmacology & Therapeutics, 44(5), 514-521. https://doi.org/10.1111/apt.13721

Stepwise diagnosis in covert hepatic encephalopathy: critical flicker frequency and MELD‐score as a first‐step approach

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