Validation of a Simple Quality‐of‐Life Score for Identification of Minimal and Prediction of Overt Hepatic Encephalopathy. Issue 9 (3rd July 2020)

• Record Type: Journal Article
• Authors: Lauridsen, Mette Munk; Jepsen, Peter; Wernberg, Charlotte Wilhelmina; Schaffalitzky de Muckadell, Ove B.; Bajaj, Jasmohan S.; Vilstrup, Hendrik
• Is Part Of: Hepatology communications. Volume 4:Issue 9(2020)
• Page Start: 1353
• Page End: 1361
• Publication Date: 2020-07-03
• Subjects: Hepatology -- Periodicals; Liver -- Diseases -- Periodicals; Liver Diseases; Gastroenterology; Periodicals; Fulltext; Internet Resources; Periodicals; 616.36
• DOI: 10.1002/hep4.1555
• Languages: English
• ISSNs: 2471-254X

Abstract

Abstract : Minimal hepatic encephalopathy (MHE) is underdiagnosed because most clinics refrain from psychometric testing. Diagnostic activities need to go up so patients with MHE can get the treatment their condition requires. The sickness impact profile questionnaire for covert hepatic encephalopathy (SIPCHE) score is based on quality‐of‐life outcomes and has been proposed as a simple, patient‐administered diagnostic score for grade 1 and MHE. Validate the SIPCHE for MHE identification and overt hepatic encephalopathy (OHE) prediction. 110 patients with liver cirrhosis (age 60 years, Model for End‐Stage Liver Disease score of 11.4, 80% blue‐collar) provided information for SIPCHE scoring: gender, age, and four SIP statements: "I do not maintain balance (physically), " "I act irritable or impatient with myself, " "I am not doing any of the usual physical recreation or activities, " and "I am eating much less than usual." MHE was diagnosed using an abnormal continuous reaction time test and/or portosystemic encephalopathy syndrome test score. Patients were followed for 2.7 years on average. SIPCHE score positivity had high sensitivity (82%) but low specificity (38%) for MHE detection. Patients with an abnormal SIPCHE had a higher incidence of OHE during follow‐up (35% vs. 14%, P = 0.05). OHE prediction sensitivity was 87% and exclusion sensitivity was 85%. The patients with an abnormal SIPCHE had twice as many subsequent episodes of OHE, and despite their high mortality, also a higher risk. An abnormal SIPCHE had a high sensitivity and low specificity for MHE identification. An abnormal SIPCHE was associated with a more than doubled risk of OHE, even with death as a competing event. SIPCHE could be used as a high‐sensitivity, low‐cost, surrogate marker of MHE in clinics without availability of psychometric tests and allow more patients to benefit from anti‐MHE treatment. Abstract : Hepatic encephalopathy should be treated before becoming overt. Here we validate a simple, quality‐of‐life–based tool for early identification of hepatic encephalopathy. This tool could be useful in settings without the availability of psychometric tests.