1. A simple covert hepatic encephalopathy screening model based on blood biochemical parameters in patients with cirrhosis.
- Author
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Miwa, Takao, Hanai, Tatsunori, Nishimura, Kayoko, Maeda, Toshihide, Tajirika, Satoko, Imai, Kenji, Suetsugu, Atsushi, Takai, Koji, Yamamoto, Mayumi, and Shimizu, Masahito
- Subjects
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HEPATIC encephalopathy , *MEDICAL screening , *CIRRHOSIS of the liver , *MULTIVARIATE analysis , *REGRESSION analysis , *LOGISTIC regression analysis - Abstract
Aim: Covert hepatic encephalopathy (CHE) adversely affects clinical outcomes in patients with liver cirrhosis, although its diagnosis is difficult. This study aimed to establish a simple CHE screening model based on blood-related biochemical parameters. Methods: This retrospective study enrolled 439 patients who were assessed for CHE using a neuropsychiatric test between January 2011 and June 2019. A simple CHE (sCHE) score was calculated with hypoalbuminemia (≤ 3.5 g/dL) and hyperammonemia (≥ 80 μg/dL) as 1 point each. The association between sCHE score and CHE or overt hepatic encephalopathy (OHE) was assessed using logistic regression and Fine-Gray competing risk regression models. Results: Of 381 eligible patients, 79 (21%) were diagnosed with CHE. The distribution of sCHE scores was 48% with 0 point, 33% with 1 point, and 19% with 2 points. Patients with sCHE score ≥ 1 point had a higher prevalence of CHE than those with sCHE score of 0 (27% vs. 14%, P = 0.002). A cut-off value of 1 point showed high discriminative ability for identifying CHE, with a sensitivity of 0.67, specificity of 0.56, positive predictive value of 0.27, and negative predictive value of 0.86. During the median follow-up period of 2.2 years, 58 (15%) patients developed OHE. Multivariate analysis showed that sCHE score ≥ 1 (sub-distribution hazard ratio [SHR], 2.69; 95% confidence interval [CI], 1.41–5.15) and CHE (SHR, 2.17; 95% CI, 1.26–3.73) independently predicted OHE. Conclusions: The sCHE score is a useful screening model for identifying patients with CHE and for predicting OHE occurrence. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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