Abstract
The psychometric hepatic encephalopathy score (PHES) is frequently used as a “gold standard” for the diagnosis of minimal hepatic encephalopathy (MHE). In Romania, there are currently no widely available tests for the detection of MHE. In this study we aimed to standardize the PHES in a healthy Romanian population and to estimate the prevalence of MHE in a group of Romanian patients with liver cirrhosis. A total of 260 healthy volunteers and 106 patients with liver cirrhosis were included in the study. The five neuropsychological tests comprising the PHES were administered to all enroled subjects. Blood samples for routine tests and serum ammonia were collected. In the healthy volunteer group age and education years were found to be predictors of all tests and gender only in two tests: digit symbol test and serial dotting test. The PHES of the healthy volunteer group was 0,43 ± 1,37 and the cut-off between normal and pathological values was set at −3 points. In the liver cirrhosis group the mean PHES was −2,44 ± 3,41, significantly lower than in the control group (p = 0,001). The estimated prevalence of MHE was 34,7 % (37 patients). In patients with cirrhosis there was a significant correlation between PHES and the severity of the liver disease according to Child-Pugh classification (r = 0,529, p = 0,001) and MELD score (r = −0,525, p = 0,001). According to our results, accurate Romanian PHES norms for the diagnosis of MHE have been developed. MHE was diagnosed in a significant proportion of Romanian patients with liver cirrhosis.
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Acknowledgments
This study was supported by the project “Excellence program in doctoral and postdoctoral research on chronic diseases”, contract number POSDRU/159/1.5/S/133377, recipient U.M.F. “Grigore T. Popa” - Iasi, co-financed by the European Social Fund through the Sectorial Operational Program for Human Resources Development 2007-2013.
The authors thank Professor Karin Weissenborn for the invaluable support.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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This study was supported by the project “Excellence program in doctoral and postdoctoral research on chronic diseases”, contract number POSDRU/159/1.5/S/133,377, recipient U.M.F. “Grigore T. Popa” - Iasi, co-financed by the European Social Fund through the Sectorial Operational Program for Human Resources Development 2007–2013.
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Badea, M.A., Drug, V.L., Dranga, M. et al. Diagnosis of minimal hepatic encephalopathy in a tertiary care center from eastern Romania: validation of the psychometric hepatic encephalopathy score (PHES). Metab Brain Dis 31, 1463–1471 (2016). https://doi.org/10.1007/s11011-016-9878-y
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DOI: https://doi.org/10.1007/s11011-016-9878-y