Sensitivity and specificity of bispectral index for classification of overt hepatic encephalopathy: a multicentre, observer blinded, validation study

Dahaba, A. A.; Worm, H. C.; Zhu, S. M.; Bao, F. P.; Salah, A.; Zakaria, S.; Bornemann, H.; Stadlbauer, V.; Rehak, P. H.; Metzler, H.; Stauber, R. E.
January 2008
Gut;Jan2008, Vol. 57 Issue 1, p77
Academic Journal
Background: The severity of hepatic encephalopathy is currently graded clinically using West Haven criteria and psychometric tests. Objective: To assess the discriminative power of the bispectral index (BIS) monitor to classify the degree and progression of hepatic encephalopathy. Design: A consecutive, multicentre, observer blinded validation study. Setting: Medical University of Graz (Graz, Austria), Zhejiang University First Affiliated Hospital (Hang Zhou, China), and Cairo University (Cairo, Egypt). Patients: 28 consecutive patients with hepatic encephalopathy were first enrolled at Medical University of Graz as a test set. The estimated BIS cut off values were subsequently tested in a validation set of 31 patients at Zhejiang University First Affiliated Hospital and 26 patients at Cairo University; 18 patients were reassessed later in a longitudinal study. Fifteen of 85 patients (18%) were excluded from the final analysis (11 became too agitated with high electromyographic activity; four fell asleep during the recording). Results: Applying the Austrian BIS cut off values of 85, 70, and 55 for discriminating West Haven grades 1 to 4 yielded agreement between BIS classification and West Haven grades in 40 of the 46 validation patients (87%), and in 16 of the 18 follow up patients (89%). Mean (SD) BIS values differed significantly between patients with West Haven grade 1 (90.2 (2.5)), grade 2 (78.4 (6.6)), grade 3 (63.2 (4.8)), and grade 4 (45.4 (5.0)). Conclusions: BIS is a useful measure for grading and monitoring the degree of involvement of the central nervous system in patients with chronic liver disease.


Related Articles

  • Introduction to the Hepatic Encephalopathy Scoring Algorithm (HESA). Tarek Hassanein; Robin Hilsabeck; William Perry // Digestive Diseases & Sciences;Feb2008, Vol. 53 Issue 2, p529 

    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...

  • Subclinical Hepatic Encephalopathy Predicts the Development of Overt Hepatic Encephalopathy. Romero-Gómez, Manuel; Boza, Fernando; García-Valdecasas, Maria Sierra; García, Emilio; Aguilar-Reina, José // American Journal of Gastroenterology;Sep2001, Vol. 96 Issue 9, p2718 

    OBJECTIVES: In patients with compensated liver cirrhosis the clinical repercussions of detecting subclinical hepatic encephalopathy (SHE) are unclear. We present a long-term follow-up study in cirrhotic patients to examine the relationship between SHE and subsequent episodes of overt hepatic...

  • Predictors of Minimal Hepatic Encephalopathy in Patients with Cirrhosis. Sharma, Praveen; Sharma, Barjesh C. // Saudi Journal of Gastroenterology;Jul2010, Vol. 16 Issue 3, p181 

    Background/Aim: Minimal hepatic encephalopathy (MHE) impairs patient's daily functioning of life. Predictors of MHE in cirrhotic patients have not been evaluated. Patients and Methods: A total of 200 cirrhotic patients (Child A, 74 [37%]; Child B, 72 [36%]; Child C, 54 [27%]) were evaluated by...

  • Hepatic Encephalopathy in End-Stage Liver Disease #188. Childers, Julie Wilson; Arnold, Robert M. // Journal of Palliative Medicine;Dec2008, Vol. 11 Issue 10, p1341 

    The article presents a medical study regarding Hepatic Encephalopathy (HE). HE is a type of neuropsychiatric syndrome which is related to end-stage liver disease. The diagnosis offers therapy and treatment to prevent HE. It further note that there is a need for support of patient from his family...

  • Covert Hepatic Encephalopathy: Does the Mini-Mental State Examination Help? Corrias, Michela; Turco, Matteo; Rui, Michele D.; Gatta, Angelo; Angeli, Paolo; Merkel, Carlo; Amodio, Piero; Schiff, Sami; Montagnese, Sara // Experimental & Clinical Hepatology;Jun2014, Vol. 4 Issue 2, p89 

    Background/objectives: The Mini-Mental State Examination (MMSE) has been utilized for the diagnosis of hepatic encephalopathy (HE). However, its threshold of abnormality has not been formally tested in patients with cirrhosis and its diagnostic/prognostic validity remains unknown. The aim of...

  • N-Acetylcysteine attenuates cerebral complications of non-acetaminophen-induced acute liver failure in mice: antioxidant and anti-inflammatory mechanisms. Bémeur, Chantal; Vaquero, Javier; Desjardins, Paul; Butterworth, Roger F. // Metabolic Brain Disease;Jun2010, Vol. 25 Issue 2, p241 

    N-acetylcysteine (NAC) is an effective antidote to treat acetaminophen (APAP)-induced acute liver failure (ALF). NAC is hepatoprotective and prevents the neurological complications of ALF, namely hepatic encephalopathy and brain edema. The protective effect of NAC and its mechanisms of action in...

  • Absence of neuropsychological impairment in hyperammonaemia in healthy young adults; possible synergism in development of hepatic encephalopathy (HE) symptoms? Wilkinson, Daniel; Smeeton, Nicholas; Castle, Paul; Watt, Peter // Metabolic Brain Disease;Sep2011, Vol. 26 Issue 3, p203 

    The aetiology of minimal hepatic encephalopathy (mHE) remains unclear. It is generally accepted that hyperammonaemia plays a major role, however there are a multitude of metabolic perturbations present. To determine the contribution of hyperammonaemia to mHE symptom development, ten healthy...

  • encephalopathy.  // Royal Society of Medicine: Medicines;2002, p226 

    This article defines encephalopathy which is any of a group of disorders that affect the functioning of the brain.

  • The Gut Hormone Profile of Fulminant Hepatic Failure. Sullivan, S. N.; Chase, R. A.; Christofides, N. D.; Bloom, S. R.; Williams, Roger // American Journal of Gastroenterology;Oct1981, Vol. 76 Issue 4, p338 

    Twenty-five patients with fulminant hepatic failure and grade III or IV hepatic encephalopathy were studied. Plasma insulin, glucagon, pancreatic polypeptide and enteroglucagon were significantly raised. Levels of secretin and gastrin were normal, while motilin concentrations were significantly...


Read the Article


Sign out of this library

Other Topics