Hepatic Encephalopathy After Transjugular Intrahepatic Portosystemic Shunt

Riggio, Oliviero; Nardelli, Silvia; Moscucci, Federica; Pasquale, Chiara; Merli, Manuela

doi:10.1016/j.cld.2011.12.008

Cited by 138 publications

(97 citation statements)

References 61 publications

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“…The results significantly worsened after TIPS placement and improved after sodium increase. Prior studies have shown that cognitive worsens after TIPS placement, which was confirmed by EncephalApp 24 . Trials have also demonstrated quality of life enhancement with hyponatremia correction, which our results extended further into the realm of EncephalApp performance 25, 26 .…”

Section: Discussionmentioning

confidence: 71%

Validation of EncephalApp, Smartphone-Based Stroop Test, for the Diagnosis of Covert Hepatic Encephalopathy

Bajaj

Heuman

Sterling

et al. 2015

Clinical Gastroenterology and Hepatology

136

124

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Background & Aims Detection of covert hepatic encephalopathy (CHE) is difficult but point of care testing could increase rates of diagnosis. We aimed to validate the ability of the smartphone app EncephalApp, a streamlined version of Stroop App, to detect CHE. We evaluated face validity, test–retest reliability, and external validity. Methods Patients with cirrhosis (n=167; 38% with overt HE [OHE]; mean age, 55 years; mean model for end-stage liver disease score, 12) and controls (n=114) were each given a paper and pencil cognitive battery (standard) along with EncephalApp. EncephalApp has Off and On states; results measured were: OffTime, OnTime, OffTime+OnTime, and number of runs required to complete 5 off and on runs. Thirty-six patients with cirrhosis underwent driving simulation tests, and EncephalApp results were correlated with results. Test–retest reliability was analyzed in a subgroup of patients. The test was performed before and after transjugular intra-hepatic portosystemic shunt placement, before and after correction for hyponatremia, to determine external validity. Results All patients with cirrhosis performed worse on paper and pencil and EncephalApp tests than controls. Patients with cirrhosis and OHE performed worse than those without OHE. Age-dependent EncephalApp cut-offs (younger or older than 45 years) were set. An OffTime+OnTime value of >190 seconds identified all patients with CHE with an area under the receiver operator characteristic (AUROC) value of 0.91; the AUROC value was 0.88 for diagnosis of CHE in those without OHE. EncephalApp times correlated with crashes and illegal turns in driving simulation tests. Test–retest reliability was high (intra-class coefficient, 0.83) among 30 patients retested 1–3 months apart. OffTime+OnTime increased significantly (206 vs 255, P=.007) among 10 patients retested 33±7 days after transjugular intra-hepatic portosystemic shunt placement. OffTime+OnTime decreased significantly (242 vs 225, P=.03) in 7 patients tested before and after correction for hyponatremia (126±3 to 132±4 meq/L, P=.01), 10±5 days apart. Conclusions A smartphone app called EncephalApp has good face validity, test–retest reliability, and external validity for the diagnosis of CHE.

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Section: Discussionmentioning

confidence: 71%

Validation of EncephalApp, Smartphone-Based Stroop Test, for the Diagnosis of Covert Hepatic Encephalopathy

Bajaj

Heuman

Sterling

et al. 2015

Clinical Gastroenterology and Hepatology

136

124

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“…Type B hepatic encephalopathy may develop acutely after transjugular intrahepatic portosystemic shunting (TIPS) procedures, 20 in which an iatrogenic portosystemic shunt is created. The likelihood of developing overt hepatic encephalopathy after TIPS varies from 15% to 48%, 21 and is higher in older patients, those with previous episodes of hepatic encephalopathy, and those with a higher Child-Pugh score.…”

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confidence: 99%

Hepatic encephalopathy due to liver cirrhosis

Ellul

Gholkar²,

Cross

2015

BMJ

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“…L'EE post-TIPS rappresenta un problema clinico di grande rilevanza, il quale non è risultato prevenibile con le terapie farmacologiche correntemente utilizzate [80]. La prevenzione dell'EE post-TIPS dovrebbe essere invece perseguita tramite una più accurata selezione dei candidati alla procedura, soprattutto tenendo conto della funzione epatica residua e dell' esistenza di precedenti episodi di EE Overt [78]. Sebbene le evidenze al riguardo siano limitate, la presenza di EE Minima nei pazienti candidati alla TIPS non sembra correlare con lo sviluppo di successivi episodi di EE Overt [81,82].…”

Section: Encefalopatia Epatica E Tipsunclassified

A look at the hepatic encephalopathy in cirrhosis

Zaccherini

Tufoni

Ricci

et al. 2013

RHC

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Hepatic encephalopathy (HE) is a neuropsychiatric syndrome complicating acute and chronic liver failure and characterized by a wide range of manifestations, in absence of other brain disease. HE is very frequent in course of cirrhosis and even mild forms involve a great additional burden on patients, their families and health-care resources. Its onset affects subsequent survival of patients. Historically, pathophysiology of HE was connected to several substances (mostly ammonia) produced in the gut and normally metabolized by the liver, but more recently other factors such as inflammation, bacterial translocation and oxidative stress have shown a crucial role. Symptoms are often overt (confusion, asterixis, disorientation, ataxia or coma) but can also be subtle (sleep disturbances, cognitive impairment, mood alterations, impairment of executive decision-making, and psychomotor speed -Minimal HE); the West Haven Criteria are most often used to grade Overt HE (OHE), with grade ranging from 0 to 4 (4 corresponding to coma). Since both Minimal HE and grade 1 HE cannot be diagnosed by clinical examination and need for specific tests, it results practical to combine these entities and name them "Covert" HE (CHE) to aid clinical use. Diagnosis is based on evidence of neurological impairment in presence of liver cirrhosis, only after the exclusion of other brain diseases. Measurement of serum ammonia and electroencephalography are little specific, while brain magnetic resonance and search for portosystemic shunts are important in complex cases. Diagnosis of OHE is often just clinical, while that of CHE requires dedicated psychometric and neurophysiological tests. Although these tests are difficult to be performed in the clinical practice, detection and treatment of CHE are cost-effective and important; indeed, CHE affects patients' quality of life, socioeconomic status and driving skills, and increases the risk for falls, car accidents, development of OHE, and death. Management of HE includes early diagnosis and prompt treatment of precipitating factors (infection, gastrointestinal bleeding, electrolyte disturbances, dehydration, hypotension, use of benzodiazepines, psychoactive drugs, and/or alcohol). Current treatment is based principally on reducing intestinal ammonia with nonabsorbable disaccharides (lactulose or lactitol); rifaximin, used solely or in addition, is also becoming a first-line treatment. Keywords Liver cirrhosis; Overt hepatic encephalopathy; Covert hepatic encephalopathy; Minimal hepatic encephalopathy Uno sguardo all'encefalopatia epatica nella cirrosiA look at the hepatic encephalopathy in cirrhosis Uno sguardo all'encefalopatia epatica nella cirrosi Introduzione L' encefalopatia epatica (EE) è una forma di sofferenza cerebrale che spesso complica il decorso della cirrosi epatica. L'EE è caratterizzata da un ampio spettro di alterazioni neuropsicologiche e neuropsichiatriche, con differenti livelli di severità, da forme subcliniche fino a stupor e coma, in assenza di altre patologie cerebra...

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Hepatic Encephalopathy After Transjugular Intrahepatic Portosystemic Shunt

Cited by 138 publications

References 61 publications

Validation of EncephalApp, Smartphone-Based Stroop Test, for the Diagnosis of Covert Hepatic Encephalopathy

Validation of EncephalApp, Smartphone-Based Stroop Test, for the Diagnosis of Covert Hepatic Encephalopathy

Hepatic encephalopathy due to liver cirrhosis

A look at the hepatic encephalopathy in cirrhosis

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