title: Bispectral index monitoring for diagnosis and assessment of severity of hepatic encephalopathy in cirrhotic patients.
abstract: BACKGROUND
  Recent evidence suggests that bispectral index may aid in the diagnosis of hepatic encephalopathy. We evaluated its utility to diagnose, grade and monitor clinical course of hepatic encephalopathy in patients with cirrhosis.
  
  
  METHODS
  200 patients (70.5% males, mean age 39.5±9.1 years) with cirrhosis and 20 healthy controls were enrolled prospectively. Cirrhotic patients were divided into groups based on encephalopathy grades I-IV assessed by West Haven criteria; minimal encephalopathy was assessed by psychometric tests. Bispectral index was measured at baseline and after one week of lactulose therapy in patients with overt encephalopathy, and after 3 months in patients with minimal encephalopathy.
  
  
  RESULTS
  Bispectral index scores were significantly different in patients with different grades of encephalopathy; 79.5±4.2, 67.5±4.3, 56.4±3.5, 44.8±3.9 and 85.0±4.3 respectively for grade I, II, III, IV overt and minimal hepatic encephalopathy, but similar (92.6±3.7 vs 93.75±2.8) in cirrhotics without encephalopathy and healthy controls. Bispectral scores' cut off values for minimal and overt encephalopathy grade I, II, III, IV were 90.5 and 77.5, 70.5, 60.5, 50.5, respectively. Changes in bispectral index after treatment corresponded to cut-off scores for grades of overt and minimal hepatic encephalopathy.
  
  
  CONCLUSIONS
  Bispectral index was found to be useful in diagnosis, grading and monitoring of treatment response in cirrhotic patients with hepatic encephalopathy.
authors.affiliation: Department of Gastroenterology and Anaesthesiology, G.B. Pant Hospital, New Delhi, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Jindal
authors.affiliation: Department of Gastroenterology and Anaesthesiology, G.B. Pant Hospital, New Delhi, India. Electronic address: drbcsharma@hotmail.com.
authors.forename: Barjesh Chander
authors.initials: BC
authors.lastname: Sharma
authors.affiliation: Department of Gastroenterology and Anaesthesiology, G.B. Pant Hospital, New Delhi, India.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Sachdeva
authors.affiliation: Department of Gastroenterology and Anaesthesiology, G.B. Pant Hospital, New Delhi, India.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Chawla
authors.affiliation: Department of Gastroenterology and Anaesthesiology, G.B. Pant Hospital, New Delhi, India.
authors.forename: Siddharth
authors.initials: S
authors.lastname: Srivastava
authors.affiliation: Department of Gastroenterology and Anaesthesiology, G.B. Pant Hospital, New Delhi, India.
authors.forename: Sudhir
authors.initials: S
authors.lastname: Maharshi
mesh_terms: D000328:Adult; D000641:Ammonia / Q000097:blood*; D016022:Case-Control Studies; D005260:Female; D006501:Hepatic Encephalopathy / Q000145:classification / Q000175:diagnosis* / Q000188:drug therapy*; D006801:Humans; D007792:Lactulose / Q000008:administration & dosage*; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011446:Prospective Studies; D011594:Psychometrics; D012372:ROC Curve; D012720:Severity of Illness Index
chemical_list: D007792:Lactulose; D000641:Ammonia
keywords: Ammonia; Chronic liver disease; Minimal hepatic encephalopathy; Overt hepatic encephalopathy; Psychometric hepatic encephalopathy score; Psychometric tests