Impact of different diagnostic criteria for assessing mild micro-hepatic encephalopathy in liver cirrhosis: an analysis based on a prospective, multicenter, real-world study
- VernacularTitle:不同诊断标准对肝硬化轻微型肝性脑病判定的影响：一项基于前瞻性、多中心、真实世界研究的分析
- Author:
Xiaoyan LI
1
;
Shanghao LIU
;
Chuan LIU
;
Hongmei ZU
;
Xiaoqing GUO
;
Huiling XIANG
;
Yan HUANG
;
Zhaolan YAN
;
Yajing LI
;
Jia SUN
;
Ruixin SONG
;
Junqing YAN
;
Qing YE
;
Fei LIU
;
Lei HUANG
;
Fanping MENG
;
Xiaoning ZHANG
;
Shaoqi YANG
;
Shengjuan HU
;
Jigang RUAN
;
Yiling LI
;
Ningning WANG
;
Huipeng CUI
;
Yanmeng WANG
;
Chuang LEI
;
Qinghai WANG
;
Hongling TIAN
;
Zhangshu QU
;
Min YUAN
;
Ruichun SHI
;
Xiaoting YANG
;
Dan JIN
;
Dan SU
;
Yijun LIU
;
Ying CHEN
;
Yuxiang XIA
;
Yongzhong LI
;
Qiaohua YANG
;
Huai LI
;
Xuelan ZHAO
;
Zemin TIAN
;
Hongji YU
;
Xiaojuan ZHANG
;
Chenxi WU
;
Zhijian WU
;
Shengqiang LI
;
Qian SHEN
;
Xuemei LIU
;
Jianping HU
;
Manqun WU
;
Tong DANG
;
Jing WANG
;
Xianmei MENG
;
Haiying WANG
;
Zhenyu JIANG
;
Yayuan LIU
;
Ying LIU
;
Suxuan QU
;
Hong TAO
;
Dongmei YAN
;
Jun LIU
;
Wei FU
;
Jie YU
;
Fusheng WANG
;
Xiaolong QI
;
Junliang FU
Author Information
- Keywords: Cirrhosis; Minimal hepatic encephalopathy; Psychometric hepatic encephalopathy score; Stroop test
- From: Chinese Journal of Hepatology 2023;31(9):961-968
- CountryChina
- Language:Chinese
- Abstract: Objective:To compare the differences in the prevalence of mild micro-hepatic encephalopathy (MHE) among patients with cirrhosis by using the psychometric hepatic encephalopathy score (PHES) and the Stroop smartphone application (Encephal App) test.Methods:This prospective, multi-center, real-world study was initiated by the National Clinical Medical Research Center for Infectious Diseases and the Portal Hypertension Alliance and registered with International ClinicalTrials.gov (NCT05140837). 354 cases of cirrhosis were enrolled in 19 hospitals across the country. PHES (including digital connection tests A and B, digital symbol tests, trajectory drawing tests, and serial management tests) and the Stroop test were conducted in all of them. PHES was differentiated using standard diagnostic criteria established by the two studies in China and South Korea. The Stroop test was evaluated based on the criteria of the research and development team. The impact of different diagnostic standards or methods on the incidence of MHE in patients with cirrhosis was analyzed. Data between groups were differentiated using the t-test, Mann-Whitney U test, and χ2 test. A kappa test was used to compare the consistency between groups. Results:After PHES, the prevalence of MHE among 354 cases of cirrhosis was 78.53% and 15.25%, respectively, based on Chinese research standards and Korean research normal value standards. However, the prevalence of MHE was 56.78% based on the Stroop test, and the differences in pairwise comparisons among the three groups were statistically significant (kappa = -0.064, P < 0.001). Stratified analysis revealed that the MHE prevalence in three groups of patients with Child-Pugh classes A, B, and C was 74.14%, 83.33%, and 88.24%, respectively, according to the normal value standards of Chinese researchers, while the MHE prevalence rates in three groups of patients with Child-Pugh classes A, B, and C were 8.29%, 23.53%, and 38.24%, respectively, according to the normal value standards of Korean researchers. Furthermore, the prevalence rates of MHE in the three groups of patients with Child-Pugh grades A, B, and C were 52.68%, 58.82%, and 73.53%, respectively, according to the Stroop test standard. However, among the results of each diagnostic standard, the prevalence of MHE showed an increasing trend with an increasing Child-Pugh grade. Further comparison demonstrated that the scores obtained by the number connection test A and the number symbol test were consistent according to the normal value standards of the two studies in China and South Korea ( Z = -0.982, -1.702; P = 0.326, 0.089), while the other three sub-tests had significant differences ( P < 0.001). Conclusion:The prevalence rate of MHE in the cirrhotic population is high, but the prevalence of MHE obtained by using different diagnostic criteria or methods varies greatly. Therefore, in line with the current changes in demographics and disease spectrum, it is necessary to enroll a larger sample size of a healthy population as a control. Moreover, the establishment of more reliable diagnostic scoring criteria will serve as a basis for obtaining accurate MHE incidence and formulating diagnosis and treatment strategies in cirrhotic populations.
