PHES: RELIABLE, BED SIDE DIAGNOSTIC TOOL IN IDENTIFICATION OF MINIMAL HEPATIC ENCEPHALOPATHY
Journal Title: Journal of Evidence Based Medicine and Healthcare - Year 2018, Vol 5, Issue 35
Abstract
BACKGROUND Hepatic Encephalopathy (HE), is a neuropsychiatric, progressive and reversible disorder and spectrum ranges from presymptomatic Minimal Hepatic Encephalopathy (MHE) to symptomatic Overt Hepatic Encephalopathy (OHE). The aim of the study is to report the usefulness of Psychometric Hepatic Encephalopathy Score (PHES) in the identification of the MHE patients. MATERIALS AND METHODS In this prospective observational randomized case-controlled analysis of data from June 2017 to December 2017, 196 patients met the inclusion criteria of the study. Out of 196 patients, 103 patients were in the control arm and 93 patients were in the study arm. We report the sensitivity, specificity, positive predictive value, negative predictive value of the PHES profile in comparison with EEG. RESULTS In our study, the demographic profile in cirrhotics and normal population showed significant difference in the mean age 57.45 ± 6.45 vs 48.10 ± 10.86 (p<0.01), education years 9.68 ± 2.22 vs 11.33 ± 2.64 (p<0.01), and blood ammonia levels 64.84 ± 52.94 vs 30 ± 12.30 (p<0.001). In the PHES variable, there is significant difference (p<0.01) in the study and control group, in PHES: Digital Symbol Test (DST), Number Connection Test-A (NCT-A), Number Connection Test-B (NCT-B), Serial Dotting Test (SDT), Line Tracing Test (LTT) and Total PHES score. The PHES profile of cirrhotic patients in the study group with and without minimal hepatic encephalopathy were respectively, PHES: DST 18.88 ± 7.08 vs. 19 ± 7.6 (p<0.01), PHES: NCT-A 67.13 ± 28.52 vs. 53.88 ± 28.52 (p<0.01), PHES: NCT-B 245.44 ± 43.78 vs. 190.63 ± 88.25 (p<0.01), PHES: SDT 92.43 ± 30.08 vs 78.6 ± 30.31 (p<0.01), PHES: LTT 161.6 ± 51.14 vs 130.01 ± 51.41 (p<0.01), and total PHES score -6.42 ± 5.7 vs. -2.35 ± 5.76 (p<0.01). The serum ammonia level was significantly increased in MHE group as compared to control, and non-MHE group and there is positive correlation between blood ammonia level and Total PHES Score. CONCLUSION Bed side PHES score can be used as a diagnostic tool to identify minimal hepatic encephalopathy patients and it shows positive correlation with blood ammonia level and EEG changes.
Authors and Affiliations
Shivani Apurva Patel, Seema Sharma, Asif Rahman, Vaibhav Daftary, Prarthi Shah
Keywords
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- EP ID EP571143
- DOI 10.18410/jebmh/2018/522
- Views 55
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