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. 2024 Sep 1;119(9):1930-1934.
doi: 10.14309/ajg.0000000000002795. Epub 2024 Apr 8.

Overt Hepatic Encephalopathy: More Than Meets the Eye

Davide Erminelli  1 , Chiara Mangini  1 , Lisa Zarantonello  1 , Paolo Angeli  1 , Sara Montagnese  1   2
Affiliations

Overt Hepatic Encephalopathy: More Than Meets the Eye

Davide Erminelli et al. Am J Gastroenterol. .

Abstract

Introduction: We aimed to assess the reliability of a qualitative approach to overt hepatic encephalopathy (OHE) diagnosis compared with the semiquantitative, and recommended one.

Methods: The above 2 methods were compared in 411 outpatients (71% males, 60 ± 10 years, model for end-stage liver disease 13.5 ± 5.0).

Results: Of the 73 patients with OHE on quantitative assessment, 19 (26%) were missed on qualitative assessment, with no difference in the likelihood of the physician missing grades II or III. Sixty-eight (20%) of the 270 patients with no OHE on quantitative assessment were wrongly qualified as having OHE.

Discussion: Qualitative clinical evaluation of OHE is not reliable, and recommendations should be followed.

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Conflict of interest statement

Guarantor of the article: Sara Montagnese, MD, PhD.

Specific author contributions: S.M.: study concept and design. D.E., C.M., L.Z., and S.M.: acquisition of data. D.E., C.M., L.Z., and S.M.: analysis and interpretation of data. D.E., C.M., and S.M.: drafting of the manuscript. P.A.: critical revision of the manuscript for important intellectual content. D.E., C.M., L.Z., and S.M.: statistical analysis. All authors have approved the final draft submitted.

Financial support: SM received a grant from Decompensated cirrhosis: identification of new combinatorial therapies based on system approaches (DECISION) Horizon 2020 (Call: H2020-SC1-BHC-2018-2020).

Potential competing interests: None to report.

Data sharing statement: The data that support the findings of this study are available on reasonable request from the corresponding author.

Figures

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Graphical abstract
Figure 1.
Figure 1.
Percentage true-positive, false-negative, false-positive, and true-negative results, by degree of hepatic encephalopathy (HE).
Figure 2.
Figure 2.
Mean ± 95% confidence interval of the variables: model for end-stage liver disease (MELD); (a) animal naming test (ANT, the higher the number of animals listed in 60 seconds, the better the performance); (b) mean Psychometric Hepatic Encephalopathy Score Z-score (MPZS, the higher the Z-score, the better the performance); (c) and the spectral EEG parameter mean dominant frequency (MDF, the higher the frequency, the better the EEG); (d) by classes of agreement between quantitative and qualitative assessment of hepatic encephalopathy. FN, false negatives; FP, false positives; TN, true negatives; TP, true positives. ^P < 0.05, ^^P < 0.01, significance of the difference between TP and FP; $P < 0.05, $$$P < 0.001, significance of the difference between FN and FP; +P < 0.001, significance of the difference between TP and TN; °°P < 0.001, significance of the difference between FN and TN; #P < 0.05, ##P < 0.01, ###P < 0.001, significance of the difference between FP and TN on post hoc comparisons (Tukey test).
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References

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