title: Comparison of the most favoured methods for the diagnosis of hepatic encephalopathy in liver transplantation candidates.
abstract: OBJECTIVE
  Hepatic encephalopathy (HE) is a common complication of liver insufficiency. While there is widespread acceptance of its importance, there is no consensus on how best to diagnose and monitor HE.
  
  
  OBJECTIVE
  To compare the four most favoured methods for the diagnosis of HE.
  
  
  METHODS
  170 patients who were on the waiting list for liver transplantation as well as 86 healthy controls were included in the study. All patients and controls underwent the portosystemic encephalopathy syndrome test yielding the psychometric hepatic encephalopathy score (PHES), the repeatable battery for the assessment of neuropsychological status (RBANS), the inhibitory control test (ICT) and critical flicker frequency (CFF) measurement.
  
  
  RESULTS
  PHES and ICT targets had the best sensitivity (85.7% vs 85.7%) and specificity (96.5% vs 97.6%) for the diagnosis of overt HE. CFF showed inferior sensitivity (40.9%) for the diagnosis of HE and dependency from previous alcohol abuse (p=0.015). Multiple regression analysis showed that all test results apart from PHES were influenced by secondary diagnoses such as diabetes mellitus and renal insufficiency.
  
  
  CONCLUSIONS
  In the German population of patients awaiting liver transplantation, PHES is the most robust method for the diagnosis and follow-up of HE.
authors.affiliation: Integrated Research and Treatment Center (IFB) Transplantation, Hannover Medical School, , Hannover, Germany.
authors.forename: Annemarie
authors.initials: A
authors.lastname: Goldbecker
authors.forename: Karin
authors.initials: K
authors.lastname: Weissenborn
authors.forename: Golschan
authors.initials: G
authors.lastname: Hamidi Shahrezaei
authors.forename: Kambiz
authors.initials: K
authors.lastname: Afshar
authors.forename: Stefan
authors.initials: S
authors.lastname: Rümke
authors.forename: Hannelore
authors.initials: H
authors.lastname: Barg-Hock
authors.forename: Christian P
authors.initials: CP
authors.lastname: Strassburg
authors.forename: Hartmut
authors.initials: H
authors.lastname: Hecker
authors.forename: Anita Blanka
authors.initials: AB
authors.lastname: Tryc
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D004522:Educational Status; D005260:Female; D005425:Flicker Fusion; D006501:Hepatic Encephalopathy / Q000175:diagnosis* / Q000523:psychology; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011594:Psychometrics; D012016:Reference Values; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014850:Waiting Lists; D055815:Young Adult
keywords: Brain/Gut Interaction; Hepatic Encephalopathy; Liver Transplantation