Inhibitory control test for the detection of minimal hepatic encephalopathy in patients with cirrhosis of liver

Sunil Taneja; Radha K Dhiman; Amit Khatri; Sandeep Goyal; Kiran K Thumbru; Ritesh Agarwal; Ajay Duseja; Yogesh Chawla

doi:10.1016/j.jceh.2012.07.001

Inhibitory control test for the detection of minimal hepatic encephalopathy in patients with cirrhosis of liver

J Clin Exp Hepatol. 2012 Dec;2(4):306-14. doi: 10.1016/j.jceh.2012.07.001. Epub 2012 Dec 16.

Authors

Sunil Taneja¹, Radha K Dhiman¹, Amit Khatri¹, Sandeep Goyal¹, Kiran K Thumbru¹, Ritesh Agarwal², Ajay Duseja¹, Yogesh Chawla¹

Affiliations

¹ Department of Hepatology, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India.
² Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India.

Abstract

Background & aims: Minimal hepatic encephalopathy (MHE) has significant impact on future clinical outcomes, such as occurrence of overt HE (OHE) and survival in patients of cirrhosis. In the absence of a 'gold standard', psychometric hepatic encephalopathy score (PHES) is widely used for the diagnosis of MHE. This cross-sectional and prospective study was carried out to determine the usefulness of inhibitory control test (ICT) for the diagnosis of MHE.

Methods: One hundred and two patients with cirrhosis and without a history of OHE were enrolled in to the study and were subjected to PHES and ICT. MHE was diagnosed when the PHES was ≤ -5. ICT was considered abnormal when the numbers of ICT lures were more than 14.

Results: Forty-one (40.2%) patients had MHE. There were 40 patients with normal PHES and ICT, 32 with abnormal PHES and ICT, 9 with abnormal PHES and normal ICT, and 21 with abnormal ICT and normal PHES score. ICT had 78% sensitivity and 65.6% specificity and an area-under-the-curve value of 0.735 (95% CI = 0.632-0.830) for the diagnosis of MHE. In patients with cirrhosis, ICT did not correlate with severity of liver disease as measured by CTP score (r = 0.044, P = 0.658) and MELD score (r = 0.176, P = 0.077). ICT did not predict survival as well as PHES; while 6 (11.3%) patients died among those who had altered ICT compared to 4 (8.2%) patients who did not have altered ICT (P = 0.74), 8 (19.5%) patients died among those who had altered PHES compared to 2 (3.3%) patients who did not have altered PHES (P = 0.013).

Conclusion: ICT is not as useful as PHES in diagnosing MHE in patients with cirrhosis of the liver. It does not correlate with disease severity and predict survival as well as PHES.

Keywords: CTP, Child–Turcotte–Pugh; FCT, figure connection test; ICT, inhibitory control test; MELD, model for end-stage liver disease; MHE, minimal hepatic encephalopathy; NCT, number connection test; OHE, overt hepatic encephalopathy; PHES, psychometric hepatic encephalopathy score; inhibitory control test, diagnosis, psychometric hepatic encepahalopahy score, natural history; minimal hepatic encephalopathy.