ArticleMetabolic brain disease2019
Diagnosis of covert hepatic encephalopathy: a multi-center study testing the utility of single versus combined testing.
Article in Metabolic brain disease, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers.
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Who cites it
22 citing papers in PubMed, 38 citations in OpenAlex.
- Diagnostic accuracy of an artificial intelligence online engine in migraine: A multi-center study.Headache · 2022Trial
- Article
- At-Home Critical Flicker Frequency Testing in Cirrhosis: A Feasibility Pilot Study Using the Novel Beacon Device.Gastro hep advances · 2026Article
- Short-term postoperative neurocognitive safety and recovery profiles of remimazolam tosilate combined with flumazenil vs. propofol in cirrhotic patients undergoing endoscopic variceal treatment: a randomized controlled trial.Frontiers in medicine · 2026Article
- Prospective evaluation of speech as a digital biomarker for covert hepatic encephalopathy.NPJ digital medicine · 2025Article
- [Interpretation of theSichuan da xue xue bao. Yi xue ban = Journal of Sichuan University. Medical science edition · 2025Article
- Interpretable machine learning model for predicting covert hepatic encephalopathy in patients with cirrhosis: a multicenter study.Frontiers in medicine · 2025Article
- Psychometric hepatic encephalopathy score (PHES) - when, how, why, and why not: a guide for the unfamiliar.Przeglad gastroenterologiczny · 2025Review
- Minimal hepatic encephalopathy: Characteristics and comparison of the main diagnostic modalities.Clinical and experimental hepatology · 2024Review
- Remote monitoring of cognition in cirrhosis and encephalopathy: future opportunity and challenge.Metabolic brain disease · 2023Review
- Assessment of Minimal Hepatic Encephalopathy with Brain MRI and EncephalApp Stroop Test.Maedica · 2023Article
- Psychometric tests, critical flicker frequency, and inflammatory indicators in covert hepatic encephalopathy diagnosis.Hepatology forum · 2023Article
- Epidemiology of liver cirrhosis and associated complications: Current knowledge and future directions.World journal of gastroenterology · 2022Review
- Minimal hepatic encephalopathy is associated to alterations in eye movements.Scientific reports · 2022Article
- Psychometric methods for diagnosing and monitoring minimal hepatic encephalopathy -current validation level and practical use.Metabolic brain disease · 2022Review
- EncephalApp Stroop Test for covert hepatic encephalopathy screening in Tunisian cirrhotic patients.F1000Research · 2022Article
- Loss of skeletal muscle mass affects the incidence of minimal hepatic encephalopathy: a case control study.BMC gastroenterology · 2020Article
- Novel computerized psychometric tests as primary screening tools for the diagnosis of minimal hepatic encephalopathy.World journal of clinical cases · 2020Review
- Outcome Prediction of Covert Hepatic Encephalopathy in Liver Cirrhosis: Comparison of Four Testing Strategies.Clinical and translational gastroenterology · 2020Article
- Diagnosis and Treatment of Hepatic Encephalopathy.Gastroenterology & hepatology · 2019Article
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Authors and funding
11 authors at 3 institutions in 1 country.
Funding
Abstract
Covert hepatic encephalopathy (CHE) affects cognition in a multidimensional fashion. Current guidelines recommend performing Psychometric Hepatic Encephalopathy Score (PHES) and a second test to diagnose CHE for multi-center trials. We aimed to determine if a two-test combination strategy improved CHE diagnosis agreement, and accuracy to predict overt hepatic encephalopathy (OHE), compared to single testing. Cirrhotic outpatients without baseline OHE performed PHES, Inhibitory Control Test (ICT), and Stroop EncephAlapp (StE) at three centers. Patients were followed for OHE development. Areas under the receiver operation characteristic curve (AUROC) were calculated. We included 437 patients (399 with follow-up data). CHE prevalence varied with testing strategy: PHES+ICT 18%, ICT + StE 25%, PHES+StE 29%, ICT 35%, PHES 37%, and StE 54%. Combination with best test agreement was PHES+StE (k = 0.34). Sixty patients (15%) developed OHE. Although CHE by StE showed the highest sensitivity to predict OHE, PHES and PHES+StE were more accurate at the expense of a lower sensitivity (55%, AUROC: 0.587; 36%, AUROC: 0.629; and 29%, AUROC: 0.623; respectively). PHES+ICT was the most specific (85%) but all strategies including ICT showed sensitivities in the 33-45% range. CHE diagnosis by PHES (HR = 1.79, p = 0.04), StE (HR = 1.69, p = 0.04), and PHES+StE (HR = 1.72, p = 0.04), were significant OHE predictors even when adjusted for prior OHE and MELD. Our results demonstrate that combined testing decreases CHE prevalence without improving the accuracy of OHE prediction. Testing with PHES or StE alone, or a PHES+StE combination, is equivalent to diagnose CHE and predict OHE development in a multi-center setting.
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