University of Illinois College of Medicine at Peoria Peoria, IL
Yeshaswini Panathur Sreenivasa Reddy, MD, Yeshaswini Reddy, University of Illinois College of Medicine at Peoria, Peoria, IL
Introduction: Hepatic encephalopathy if not recognised and treated appropriately can result in increased mortality and morbidity in cirrhosis. The gold standard tests available to diagnose covert hepatic encephalopathy (CHE) such as the Psychometric Hepatic Encephalopathy score (PHES) are prohibitively expensive and time consuming. Therefore we propose a simple memory and computation based test as an alternative to help quickly and efficiently diagnose CHE.
Methods: The 36 cent test is performed by asking them to give 2 different combinations of coins for 36 cents and should be answered within 2 minutes without prompting. If easily able to answer both questions they will be scored 2 points (1 point per combination). However, if the patient is able to answer the questions but takes more time ( >2 minutes) or needs repeated prompting, they will be scored 1 point and if they are unable to answer either of the questions they score 0 points. A score of 1 or less is considered to have CHE. Then the PHES tests which includes: line tracing test, serial dotting test, digit symbol test, and number connection test A and B are performed during the same visit. The sum of 5 test scores will be obtained ranging from +6 to -18 and a cut off score of -4 or less is considered to diagnose CHE based on the Spain normality tables ( www.redeh.org). The outcome was measured by calculating the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).
Results: A total of 10 radiographically or histologically confirmed cirrhotic patients were included in this study. None of them had any prior episodes of encephalopathy. Patients included in this analysis were between the age of 30 - 65 years. Out of the 10 patients, 6 were female and 4 were male. The sensitivity of the 36 cent test was 66% (2 / 3). The 36 cent test had a specificity of 100% (7 / 7). The PPV of this test was 100% (2 / 2). The 36 cent test had a NPV of 87% (7 / 8). These findings are summaries in table 1.
Discussion: The 36 cent test will test the working memory and the ability to process information accurately in a timely manner. This is further supported with the high specificity and moderate sensitivity in this pilot study. We suggest using the 36 cent test, given the advantages of being simple to perform, easy to interpret, and the negligible cost. The 36 cent test can be used as an alternative to diagnose CHE.
Test positive
Test negative
CHE present
2
1
CHE absent
0
7
Table: Table 1 showing the Statistical analysis
Disclosures:
Yeshaswini Panathur Sreenivasa Reddy indicated no relevant financial relationships.
Yeshaswini Reddy indicated no relevant financial relationships.
Yeshaswini Panathur Sreenivasa Reddy, MD, Yeshaswini Reddy, . C0489 - Simple Diagnostic Test to Detect Covert Hepatic Encephalopathy: A Pilot Study, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.
