Background

Psychometric hepatic encephalopathy score (PHES) needs local standardization.

Aims

This study aimed at standardizing PHES for Turkish patients and compare them with German norms; to determine minimal hepatic encephalopathy (mHE) prevalence with two different methods [PHES battery and Critical Flicker Frequency (CFF)] and to assess whether sub-tests of the battery can be used for screening for mHE.

Methods

Healthy volunteers (n = 816; 400 male) and cirrhotics (n = 124; 58 male) were included. For mHE diagnosis PHES score threshold was set at ≤ − 5 points and that of CFF at < 39 Hz. For comparing German and Turkish norms, datasets were combined. Multiple backward procedure was applied to assess effects of age, sex and education on single tests of the battery. Receiver operating characteristic (ROC) curves were created for assessing diagnostic capabilities of subtests of the battery.

Results

PHES norms for Turks were developed. MHE prevalence in compensated cirrhotics was 29.8% and 27.4% with PHES and CFF tests, respectively, with low compatibility (kappa coefficient 0.389); mHE prevalence decreased to 16% when both tests were combined. Turks performed worse vs Germans in the digit symbol (DS) and serial dotting (SD) subtests but performed better in other subtests. In ROC analyzes of subtests, the combination of DS + SD tests achieved an AUROC of 0.974 versus PHES.

Conclusions

Use of two methods for diagnosing mHE is important for research purposes. From a clinical perspective, sensitivity with acceptable specificity may suffice for screening instruments for mHE. Combined use of DS and SD subtests of the PHES battery appears suitable for this purpose.

中文翻译：

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确定土耳其诊断轻微肝性脑病心理测试标准并提出高灵敏度筛查测试组

 背景

心理测量性肝性脑病评分（PHES）需要当地标准化。

 目标

本研究旨在标准化土耳其患者的 PHES，并将其与德国标准进行比较；使用两种不同的方法 [PHES 电池和临界闪烁频率 (CFF)] 确定轻微肝性脑病 (mHE) 患病率，并评估电池的子测试是否可用于筛查 mHE。

 方法

包括健康志愿者（ n = 816；400 名男性）和肝硬化志愿者（ n = 124；58 名男性）。对于 mHE 诊断，PHES 评分阈值设置为 ≤ − 5 分，CFF 评分阈值设置为 < 39 Hz。为了比较德国和土耳其的标准，合并了数据集。采用多重后向程序来评估年龄、性别和教育程度对电池单次测试的影响。创建接收器操作特性 (ROC) 曲线用于评估电池子测试的诊断能力。

 结果

为土耳其人制定了 PHES 规范。 PHES和CFF测试的代偿性肝硬化患者MHE患病率分别为29.8%和27.4%，兼容性较低（kappa系数0.389）；当两项测试合并时，mHE 患病率下降至 16%。土耳其人在数字符号（DS）和连续点（SD）子测试中比德国人表现更差，但在其他子测试中表现更好。在子测试的 ROC 分析中，与 PHES 相比，DS + SD 测试的组合实现了 0.974 的 AUROC。

 结论

使用两种方法诊断 mHE 对于研究目的很重要。从临床角度来看，灵敏度和可接受的特异性可能足以用于 mHE 的筛查仪器。 PHES 电池的 DS 和 SD 子测试的组合使用似乎适合此目的。