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Utility of critical flicker frequency threshold and neuropsychological test in predicting overt hepatic encephalopathy.


Ma Fatima P. Calida,
Diana A. Payawal,
Ismael A. Lapus,
John Ray M. Gonzales

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Journal Article, Original
Philippine Journal of Gastroenterology
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Introduction: Minimal hepatic encephalopathy (MHE) presents in 30 to 84 percent of patients with cirrhosis depending on the diagnostic techniques and population used. The clinical significance of progression to overt hepatic encephalopathy (HE) has not been established. This study was conducted to compare the diagnostic usefulness of Critical Flicker Frequency (CFF) with that of Number Connection Test (NCT) in the detection of MHE, and to examine the natural course of MHE if left untreated.

Materials and Methods: Adult cirrhotic and non-cirrhotic patients of either sex, with no clinical evidence of encephalopathy, based on their mental status examination (Wes-Haven Criteria) seen at the outpatient department of Cardinal Santos Medical Center from 2005 to 2006 were included in the study. The cirrhotic and non-cirrhotic patients were both subjected to CFF and NCT A and B, which were performed on the same day in a quiet room. All patients were followed up clinically for at least six months. The Hepatonorm analyzer version 2003 was used to perform the CFF test, where a threshold of 39 Hz or below was taken as indicative of HE. NCT A and B were also conducted, in which a time of 40 seconds or more was considered positive for HE.

Results: Forty-one cirrhotic patients and 39 non-cirrhotic controls were enrolled in the study. Among the cirrhotic patients, 26 (63 percent) patients tested by CFF and 34 (83 percent) subjected to NCT A and B were found to have HE; among the non-cirrhotic patients, five (13 percent) patients tested by CFF and 10 (26 percent) patients subjected to NCT A and B were found to have HE. Ten (24.4 percent) patients with HE identified by NCT or CFF progressed to develop overt HE within the duration of observation of six months.

Conclusion: It is therefore important to recognize that the presence of MHE may predict the occurrence of overt HE and probably portend a poorer prognosis.

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