Useful Tests for Hepatic Encephalopathy in Clinical Practice

Abstract

Hepatic encephalopathy (HE) is a serious complication of liver disease and portosystemic shunting that represents a continuum of neuropsychiatric changes and altered consciousness. It is classified as overt hepatic encephalopathy (OHE) when clinically apparent or as covert hepatic encephalopathy (CHE) in its mildest form. Progression of CHE to OHE and its impact of quality of life make its early diagnosis imperative. Several diagnostic techniques ranging from simple clinical scales to sophisticated computerized tests exist yet diagnosis remains a challenge due to the time, cost and personnel involved. Psychometric tests appear promising due to their high sensitivity and low cost but results are variable depending on age and education. The pros and cons of current diagnostic methods for overt and covert HE are reviewed along with strategy to CHE testing.

Legal Responsibilities of Physicians When They Diagnose Hepatic Encephalopathy

“…3,5 As noted earlier, a variety of tests were performed to categorize cirrhotic subjects into groups with and without CHE. The battery of tests used to conduct current research in CHE cannot readily be used (or readily afforded) in clinical practice.…”

“…Among the methods used to establish the diagnosis of CHE are standardized psychometric batteries, neuropsychological testing, computerized testing, and comprehensive neuropsychological examinations. 3 Several of these tests are copyrighted and require a specific psychological or neurologic expertise for access, administration, and interpretation. As a result, most hepatologists responding to an American Association for the Study of Liver Diseases survey noted an inability to test cirrhotic patients for CHE.…”

Reversibility of minimal hepatic encephalopathy following liver transplantation in Egyptian cirrhotic patients

“…The portosystemic encephalopathy battery was introduced later to exclude tests with poor sensitivity. It includes the line tracing test (LTT) and/or the digit symbol test, in addition to the number connection tests A and B (NCT A and B)[5]. The sum of the scores of these tests ranges between +5 and -15.…”

Grading the range of hepatic encephalopathy from overt to covert: Animals to the rescue!

“…. The analysis of S‐ANT1 has moved the discussion forward in the latest trend in making tools to diagnose covert HE without specialized tests …”

“…The analysis of S-ANT1 has moved the discussion forward in the latest trend in making tools to diagnose covert HE without specialized tests. (10) Although the S-ANT1 will not resolve all of the issues in the differentiation between unimpaired and covert and within the covert stages, it does represent a step forward through which HE grading can be uniform in the real world. However, further studies are needed to validate and evaluate this new tool in geographically and culturally diverse cohorts as well as in interventional clinical trials.…”