Digestive Diseases and Sciences

, Volume 53, Issue 2, pp 529–538

Introduction to the Hepatic Encephalopathy Scoring Algorithm (HESA)

  • Tarek I. Hassanein
  • Robin C. Hilsabeck
  • William Perry
Original Paper

Abstract

A primary obstacle to early diagnosis and treatment of hepatic encephalopathy (HE) is the lack of a well-validated, standardized assessment method. The purpose of this study was to present preliminary validity data on a new method of grading HE, the Hepatic Encephalopathy Scoring Algorithm (HESA), which combines clinical impressions with neuropsychological performances to characterize HE. Participants were 49 inpatients admitted for complications of end stage liver disease. Each participant’s level of HE was graded using HESA and the West Haven Criteria (WHC) by independent raters blinded to each other’s rating. A moderately strong association was found between the two grading methods (r = 0.60), and individual HESA clinical and neuropsychological indicators were good discriminators among grades. The results also suggest HESA may be more sensitive to mental status impairment in the middle grades of HE than WHC. These findings suggest HESA holds promise as a multi-method approach to grading all levels of HE.

Keywords

Chronic liver disease Cognitive impairment End stage liver disease Hepatitis C Hepatic encephalopathy Neuropsychological assessment 

References

  1. 1.
    Groeneweg M, Quero JC, De Bruijn I, Hartmann IJC, Essink-Bot M, Hop WCJ, Schalm SW (1998) Subclinical hepatic encephalopathy impairs daily functioning. Hepatology 28:45–49PubMedCrossRefGoogle Scholar
  2. 2.
    Bustamante J, Rimola A, Ventura PJ, Navasa M, Ciera I, Reggiardo V, Rodes J (1999) Prognostic significance of hepatic encephalopathy in patients with cirrhosis. J Hepatol 30:890–895PubMedCrossRefGoogle Scholar
  3. 3.
    Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei AT and the Members of the Working Party (2002) Hepatic encephalopathy – definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology. Hepatology 35:716–721Google Scholar
  4. 4.
    Montagnese S, Amodio P, Morgan MY (2004) Methods for diagnosing hepatic encephalopathy in patients with cirrhosis: a multidimensional approach. Metab Brain Dis 19:281–312PubMedCrossRefGoogle Scholar
  5. 5.
    Conn HO, Leevy CM, Vlahcevic ZR, Rodgers JB, Maddrey WC, Seeff L, Levy LL (1977) Comparison of lactulose and neomycin in the treatment of chronic portal-systemic encephalopathy. Gastroenterology 72:573–583PubMedGoogle Scholar
  6. 6.
    Atterbury CE, Maddrey WC, Conn HO (1978) Neomycin-sorbitol and lactulose in the treatment of acute portal-systemic encephalopathy. A controlled, double-blind clinical trail. Am J Dig Dis 23:398–406PubMedCrossRefGoogle Scholar
  7. 7.
    Huda A, Guze BH, Thomas MA, Bugbee M, Fairbanks L, Strouse T, Fawzy FI (1998) Clinical correlation of neuropsychological test with H magnetic resonance spectroscopy in hepatic encephalopathy. Psychosom Med 60:550–556PubMedGoogle Scholar
  8. 8.
    Quero Guillen JC, Soria IC, Garcia Montes JM, Jimenez Saenz M, Herrarias Gutierrez JM (2003) Hepatic encephalopathy: nomenclature, pathogenesis, and treatment. Rev Esp Enferm Dig 95:135–142PubMedGoogle Scholar
  9. 9.
    Amodio P, Montagnese S, Gatta A, Morgan MY (2004) Characteristics of minimal hepatic encephalopathy. Metab Brain Dis 19:253–267PubMedCrossRefGoogle Scholar
  10. 10.
    Blei AT (1996) Hepatic encephalopathy. In: Kaplowitz N (ed) Liver and biliary diseases, 2nd edn. Williams & Wilkins, Baltimore, pp 615–628Google Scholar
  11. 11.
    Wechsler D (1987) Wechsler Memory Scale – Revised: manual. The Psychological Corp, San AntonioGoogle Scholar
  12. 12.
    Brandt J (1991) The Hopkins Verbal Learning Test: development of a new memory test with six equivalent forms. Clin Neuropsychol 5:125–142CrossRefGoogle Scholar
  13. 13.
    Benedict RHB (1997) Brief Visuospatial Memory Test – Revised: manual. The Psychological Corp, San AntonioGoogle Scholar
  14. 14.
    Tryon WW, Orr DA, Blumenfield M (1996) Psychometric equivalency of an electronic visual-analog (EVA), a conventional visual-analog, and a Likert rating scale. Int J Method Psychiatric Res 6:123–127CrossRefGoogle Scholar
  15. 15.
    Maurer TJ, Pierce HR (1998) A comparison of Likert scale and traditional measures of self-efficacy. J Appl Psychol 83:324–329CrossRefGoogle Scholar
  16. 16.
    Jensen MP, Turner JA, Romano JM, Fisher LD (1999) Comparative reliability and validity of chronic pain intensity measures. Pain 83:157–162PubMedCrossRefGoogle Scholar
  17. 17.
    Wilkinson GS (1993) Wide Range Achievement Test – 3rd revision: manual. The Psychological Corp, San AntonioGoogle Scholar
  18. 18.
    Wechsler D (1997) Wechsler Adult Intelligence Scale – 3rd edition: manual. The Psychological Corp, San AntonioGoogle Scholar
  19. 19.
    Randolph C (1998) Repeatable battery for the assessment of neuropsychological status: manual. The Psychological Corp, San AntonioGoogle Scholar
  20. 20.
    Gilberstadt S, Gilberstadt H, Zieve L, Buegel B, Collier R, McClain C (1980) Psychomotor performance deficits in cirrhotic patients without overt encephalopathy. Arch Int Med 140:519–521CrossRefGoogle Scholar
  21. 21.
    McCrea M, Cordoba J, Vessey G, Blei AT, Randolph C (1996) Neuropsychological characterization and detection of subclinical hepatic encephalopathy. Arch Neurol 53:758–763PubMedGoogle Scholar
  22. 22.
    Weissenborn K, Ennen JC, Schomerus H, Ruckert N, Hecker H (2001) Neuropsychological characterization of hepatic encephalopathy. J Hepatol 34:768–773PubMedCrossRefGoogle Scholar
  23. 23.
    Hassanein T, Tofteng F, Brown RS, McGuire B, Lynch P, Mehta R, Larsen FS, Gornbein J, Stange J, Blei AT (2007) Randomized controlled study of extracorporeal albumin dialysis for hepatic encephalopathy in advanced cirrhosis. Hepatology (in press)Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Tarek I. Hassanein
    • 1
  • Robin C. Hilsabeck
    • 2
  • William Perry
    • 2
  1. 1.Department of Medicine, Hepatology Neurobehavioral Research Program, UCSD Liver CenterUniversity of CaliforniaSan DiegoUSA
  2. 2.Department of Psychiatry, Hepatology Neurobehavioral Research Program, UCSD Liver CenterUniversity of CaliforniaSan DiegoUSA

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