title: Modified-orientation log to assess hepatic encephalopathy.
abstract: BACKGROUND
  The subjectivity of the West-Haven criteria (WHC) hinders hepatic encephalopathy (HE) evaluation. The new HE classification has emphasised assessment of orientation. The modified-orientation log (MO-log, eight questions, scores 0-24; 24 normal) is adapted from a validated brain injury measure.
  
  
  OBJECTIVE
  To validate MO-log for HE assessment in cirrhosis.
  
  
  METHODS
  Cirrhotics admitted with/without HE were administered MO-log. We collected cirrhosis/HE details, admission/daily MO-logs and WHC (performed by different examiners), time to reach normal mentation (MO-log ≥23) and MO-log/WHC change (Δ) over day 1. Outcomes were in-hospital mortality, duration to normal mentation and length-of-stay (LOS). Regressions were performed for each outcome. MO-log inter-rater reliability was measured.
  
  
  RESULTS
  Ninety-six HE (55 ± 8 years, MELD 21) and 20 non-HE (54 ± 5 years, MELD 19) in-patients were included. In HE patients, median admission WHC was 3 (range 1-4). Mean MO-log was 12 ± 8 (range 0-22). Their LOS was 6 ± 5 days and 13% died. Time to reach normal mentation was 2.4 ± 1.7 days. Concurrent validity: there was a significant negative correlation between admission MO-log and WHC (r = -0.79, P < 0.0001). Discriminant validity: admission MO-logs were significantly lower in those who died (7 vs. 12, P = 0.03) and higher in those admitted without HE (23.6 vs. 12, P < 0.0001). MO-log improved in 69% on day 1 (ΔMO-log 4 ± 8) which was associated with lower duration to normal mentation (2 vs. 3.5 days, P = 0.03) and mortality (3% vs.43%, P < 0.0001), not ΔWHC. Regression models for all outcomes included admission/ΔMO-log but not WHC as a predictor. Inter-rater reliability: ICC for MO-log inter-rater observations was 0.991.
  
  
  CONCLUSIONS
  Modified-orientation log is a valid tool for assessing severity and is better than West-Haven criteria in predicting outcomes in hospitalised hepatic encephalopathy patients.
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, USA.
authors.forename: M
authors.initials: M
authors.lastname: Salam
authors.forename: S
authors.initials: S
authors.lastname: Matherly
authors.forename: I S
authors.initials: IS
authors.lastname: Farooq
authors.forename: R T
authors.initials: RT
authors.lastname: Stravitz
authors.forename: R K
authors.initials: RK
authors.lastname: Sterling
authors.forename: A J
authors.initials: AJ
authors.lastname: Sanyal
authors.forename: D P
authors.initials: DP
authors.lastname: Gibson
authors.forename: J B
authors.initials: JB
authors.lastname: Wade
authors.forename: L R
authors.initials: LR
authors.lastname: Thacker
authors.forename: D M
authors.initials: DM
authors.lastname: Heuman
authors.forename: M
authors.initials: M
authors.lastname: Fuchs
authors.forename: P
authors.initials: P
authors.lastname: Puri
authors.forename: V
authors.initials: V
authors.lastname: Luketic
authors.forename: S J
authors.initials: SJ
authors.lastname: Bickston
authors.forename: J S
authors.initials: JS
authors.lastname: Bajaj
mesh_terms: D005260:Female; D006501:Hepatic Encephalopathy / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires