Validation of a Simple Quality‐of‐Life Score for Identification of Minimal and Prediction of Overt Hepatic Encephalopathy

Abstract

Minimal hepatic encephalopathy (MHE) is underdiagnosed because most clinics refrain from psychometric testing. Diagnostic activities need to go up so patients with MHE can get the treatment their condition requires. The sickness impact profile questionnaire for covert hepatic encephalopathy (SIPCHE) score is based on quality‐of‐life outcomes and has been proposed as a simple, patient‐administered diagnostic score for grade 1 and MHE. Validate the SIPCHE for MHE identification and overt hepatic encephalopathy (OHE) prediction. 110 patients with liver cirrhosis (age 60 years, Model for End‐Stage Liver Disease score of 11.4, 80% blue‐collar) provided information for SIPCHE scoring: gender, age, and four SIP statements: “I do not maintain balance (physically),” “I act irritable or impatient with myself,” “I am not doing any of the usual physical recreation or activities,” and “I am eating much less than usual.” MHE was diagnosed using an abnormal continuous reaction time test and/or portosystemic encephalopathy syndrome test score. Patients were followed for 2.7 years on average. SIPCHE score positivity had high sensitivity (82%) but low specificity (38%) for MHE detection. Patients with an abnormal SIPCHE had a higher incidence of OHE during follow‐up (35% vs. 14%, P = 0.05). OHE prediction sensitivity was 87% and exclusion sensitivity was 85%. The patients with an abnormal SIPCHE had twice as many subsequent episodes of OHE, and despite their high mortality, also a higher risk. An abnormal SIPCHE had a high sensitivity and low specificity for MHE identification. An abnormal SIPCHE was associated with a more than doubled risk of OHE, even with death as a competing event. SIPCHE could be used as a high‐sensitivity, low‐cost, surrogate marker of MHE in clinics without availability of psychometric tests and allow more patients to benefit from anti‐MHE treatment.

Quality of life as a therapeutic objective in the management of hepatic encephalopathy and the potential role of rifaximin-α

“…Tests validated for use in covert hepatic encephalopathy may prove useful in this regard; for example, the Clinical Covert Hepatic Encephalopathy score has been developed and validated for use as an easy-to-perform measure for identifying patients with cirrhosis at risk of covert hepatic encephalopathy, which has been shown to correlate with QoL and the risk of first-time overt hepatic encephalopathy [20]. Similarly, the Sickness Impact Profile questionnaire for Covert Hepatic Encephalopathy score is based on QoL outcomes and has been developed and validated as a simple, patient-administered, diagnostic measure to identify patients at high risk of developing overt hepatic encephalopathy who might benefit from prophylactic therapy [21]. Another explanation for this unexpected low rate of formal assessment of QoL in clinical practice may be related to a lack of precision of the question related to this item.…”

Prediction and prevention of the first episode of overt hepatic encephalopathy in patients with cirrhosis

“…While this study did not evaluate the predictive value of the SIP CHE score regarding OHE prediction, a Danish validation study was able to demonstrate that the SIP CHE score had a prediction sensitivity of 87% for future OHE episodes. 55 However, it has to be kept in mind when interpreting these findings that patients with and without a history of OHE were combined. Another German study chose a comparable approach to develop and validate the Clinical Covert HE score (CCHE score), which comprises the variables ascites, history of OHE, albumin serum levels, the activity subdomain of the Chronic Liver Disease Questionnaire, and the performance in ANT.…”

Steatotic liver disease is the most important somatic determinant of quality of life in patients with obesity: A cross‐sectional study

“…As a reference group, we post hoc added SIP information from a group of patients with liver cirrhosis (n = 111) who had completed the SIP questionnaire in a different project. 20 Both studies were conducted in accordance with the guidelines of the Declaration of Helsinki and the principles of good clinical practice.…”

“…As a reference group, we post hoc added SIP information from a group of patients with liver cirrhosis ( n = 111) who had completed the SIP questionnaire in a different project 20 . This group included 68% white Danish males, with a mean age of 60 years (SD: 8.7), a median Child‐Pugh score of 6 (IQR: 6–8), and an average of 10.8 years of formal education (SD: 2.4).…”