Clinical Usefulness of the Inhibitory Control Test (ICT) in the Diagnosis of Minimal Hepatic Encephalopathy

Abstract

Background: Minimal hepatic encephalopathy (MHE) refers to a number of neuropsychiatric and neurophysiological disorders in patients with cirrhosis who do not show abnormalities on physical examination or in clinical tests. The aim of this study was to determine the prevalence, risk factors, and predictive value of minimal hepatic encephalopathy and the usefulness of the inhibitory control test (ICT) in the diagnosis. Methods: Seventy patients (mean age 53 years, range 24−77) with liver cirrhosis were enrolled in the study. MHE was diagnosed based on PHES (psychometric hepatic encephalopathy score) and ICT. PHES and ICT were validated in a group of 56 control subjects. Results: Minimal hepatic encephalopathy was diagnosed using PHES in 21 patients (30%). ICT diagnosed MHE in 30 patients (42%), and the test had a sensitivity of 65% and a specificity of 57% compared to PHES. The ICT score (lures/target accuracy rate) correlated with the age of subjects (R = 0.35, p = 0.002) and only slightly with education (education in years R = −0.22, p = 0.06). MHE diagnosed with PHES or ICT was associated with a significantly higher model of end-stage liver disease (MELD) score in the follow-up. MHE diagnosed with ICT was correlated with a significantly higher incidence of symptoms of decompensated cirrhosis (p = 0.02) in the follow-up. Conclusions: ICT had moderate sensitivity and specificity in diagnosing MHE compared to PHES. Importantly, MHE detected with PHES or ICT was associated with poorer survival and a more severe progression of the disease.

Clinical efficiency of inhibitory control test for the diagnosis of minimal hepatic encephalopathy: A systematic review with meta‐analysis

“…After duplicates were removed, a total of 48 studies were identified in the present study, of which 36 were excluded from the analysis according to the inclusion and exclusion criteria; the remaining 12 studies 6,9–19 were included in the systematic review (Figure 2). The characteristics of these 12 studies are presented in Table 1.…”

“…The characteristics of these 12 studies are presented in Table 1. Three 6,10,19 of 12 studies were published before 2010, and nine studies 9,11–18 were published after 2010. All 12 studies 6,9–19 enrolled patients with different etiologies of liver cirrhosis, including viral hepatitis, alcohol hepatitis, autoimmune hepatitis, nonalcoholic steatohepatitis, primary biliary cirrhosis, primary sclerosing cholangitis, and cryptogenic cirrhosis.…”

“…Three 6,10,19 of 12 studies were published before 2010, and nine studies 9,11–18 were published after 2010. All 12 studies 6,9–19 enrolled patients with different etiologies of liver cirrhosis, including viral hepatitis, alcohol hepatitis, autoimmune hepatitis, nonalcoholic steatohepatitis, primary biliary cirrhosis, primary sclerosing cholangitis, and cryptogenic cirrhosis. Eight studies 9,11–13,15–18 used PHES as their reference test, whereas the other four studies 6,10,14,19 used SPT as the reference test.…”

“…All 12 studies 6,9–19 enrolled patients with different etiologies of liver cirrhosis, including viral hepatitis, alcohol hepatitis, autoimmune hepatitis, nonalcoholic steatohepatitis, primary biliary cirrhosis, primary sclerosing cholangitis, and cryptogenic cirrhosis. Eight studies 9,11–13,15–18 used PHES as their reference test, whereas the other four studies 6,10,14,19 used SPT as the reference test. The locations of 12 studies were United States (four studies 6,10,12,19 ), India (five studies 13–15,17,18 ), Italy (one study 9 ), Germany (one study 16 ), and Poland (one study 11 ).…”

“…In recent decades, the ICT has been applied for MHE diagnosis in the United States, Germany, Italy, Poland, and India (Table 1). 6,9–19 Several studies indicated that the ICT is a rapid and convenient method for MHE diagnosis in patients with liver cirrhosis; however, its efficiency is influenced by educational level and cultural differences 9,10,13,15,18 . Therefore, in this study, the clinical evidence concerning the ICT application was systematically summarized, and subsequently, a meta‐analysis was undertaken to evaluate its efficiency for MHE diagnosis.…”