The PHES battery does not detect all cirrhotic patients with early neurological deficits, which are different in different patients.
<h4>Background and aims</h4>The psychometric hepatic encephalopathy score (PHES) is the "gold standard" for minimal hepatic encephalopathy (MHE) diagnosis. Some reports suggest that some cirrhotic patients "without" MHE according to PHES show neurological deficits and...
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Public Library of Science (PLoS)
2017-01-01
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| author | Carla Giménez-Garzó Juan José Garcés Amparo Urios Alba Mangas-Losada Raquel García-García Olga González-López Remedios Giner-Durán Desamparados Escudero-García Miguel Angel Serra Emilio Soria Vicente Felipo Carmina Montoliu |
| author_facet | Carla Giménez-Garzó Juan José Garcés Amparo Urios Alba Mangas-Losada Raquel García-García Olga González-López Remedios Giner-Durán Desamparados Escudero-García Miguel Angel Serra Emilio Soria Vicente Felipo Carmina Montoliu |
| author_sort | Carla Giménez-Garzó |
| collection | DOAJ |
| description | <h4>Background and aims</h4>The psychometric hepatic encephalopathy score (PHES) is the "gold standard" for minimal hepatic encephalopathy (MHE) diagnosis. Some reports suggest that some cirrhotic patients "without" MHE according to PHES show neurological deficits and other reports that neurological alterations are not homogeneous in all cirrhotic patients. This work aimed to assess whether: 1) a relevant proportion of cirrhotic patients show neurological deficits not detected by PHES; 2) cirrhotic patients with mild neurological deficits are a homogeneous population or may be classified in sub-groups according to specific deficits.<h4>Methods</h4>Cirrhotic patients "without" (n = 56) or "with" MHE (n = 41) according to PHES and controls (n = 52) performed psychometric tests assessing attention, concentration, mental processing speed, working memory and bimanual and visuomotor coordination. Heterogeneity of neurological alterations was analysed using Hierarchical Clustering Analysis.<h4>Results</h4>PHES classified as "with" MHE 42% of patients. Around 40% of patients "without" MHE according to PHES fail two psychometric tests. Oral SDMT, d2, bimanual and visuo-motor coordination tests are failed by 54, 51, 51 and 43% of patients, respectively. The earliest neurological alterations are different for different patients. Hierarchical clustering analysis shows that patients "without" MHE according to PHES may be classified in clusters according to the tests failed. In some patients coordination impairment appear before cognitive impairment while in others concentration and attention deficits appear before.<h4>Conclusions</h4>PHES is not sensitive enough to detect early neurological alterations in a relevant proportion of cirrhotic patients. Oral SDMT, d2 and bimanual and visuo-motor coordination tests are more sensitive. The earliest neurological alterations are different in different cirrhotic patients. These data also have relevant clinical implications. Patients classified as "without MHE" by PHES belonging to clusters 3 and 4 in our study have a high risk of suffering clinical complications, including overt HE and must be diagnosed and clinically followed. |
| format | Article |
| id | doaj-art-ad66b2aaa60a48fca8cf7a43e5caeb4d |
| institution | DOAJ |
| issn | 1932-6203 |
| language | English |
| publishDate | 2017-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
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| spelling | doaj-art-ad66b2aaa60a48fca8cf7a43e5caeb4d2025-08-20T02:46:01ZengPublic Library of Science (PLoS)PLoS ONE1932-62032017-01-01122e017121110.1371/journal.pone.0171211The PHES battery does not detect all cirrhotic patients with early neurological deficits, which are different in different patients.Carla Giménez-GarzóJuan José GarcésAmparo UriosAlba Mangas-LosadaRaquel García-GarcíaOlga González-LópezRemedios Giner-DuránDesamparados Escudero-GarcíaMiguel Angel SerraEmilio SoriaVicente FelipoCarmina Montoliu<h4>Background and aims</h4>The psychometric hepatic encephalopathy score (PHES) is the "gold standard" for minimal hepatic encephalopathy (MHE) diagnosis. Some reports suggest that some cirrhotic patients "without" MHE according to PHES show neurological deficits and other reports that neurological alterations are not homogeneous in all cirrhotic patients. This work aimed to assess whether: 1) a relevant proportion of cirrhotic patients show neurological deficits not detected by PHES; 2) cirrhotic patients with mild neurological deficits are a homogeneous population or may be classified in sub-groups according to specific deficits.<h4>Methods</h4>Cirrhotic patients "without" (n = 56) or "with" MHE (n = 41) according to PHES and controls (n = 52) performed psychometric tests assessing attention, concentration, mental processing speed, working memory and bimanual and visuomotor coordination. Heterogeneity of neurological alterations was analysed using Hierarchical Clustering Analysis.<h4>Results</h4>PHES classified as "with" MHE 42% of patients. Around 40% of patients "without" MHE according to PHES fail two psychometric tests. Oral SDMT, d2, bimanual and visuo-motor coordination tests are failed by 54, 51, 51 and 43% of patients, respectively. The earliest neurological alterations are different for different patients. Hierarchical clustering analysis shows that patients "without" MHE according to PHES may be classified in clusters according to the tests failed. In some patients coordination impairment appear before cognitive impairment while in others concentration and attention deficits appear before.<h4>Conclusions</h4>PHES is not sensitive enough to detect early neurological alterations in a relevant proportion of cirrhotic patients. Oral SDMT, d2 and bimanual and visuo-motor coordination tests are more sensitive. The earliest neurological alterations are different in different cirrhotic patients. These data also have relevant clinical implications. Patients classified as "without MHE" by PHES belonging to clusters 3 and 4 in our study have a high risk of suffering clinical complications, including overt HE and must be diagnosed and clinically followed.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0171211&type=printable |
| spellingShingle | Carla Giménez-Garzó Juan José Garcés Amparo Urios Alba Mangas-Losada Raquel García-García Olga González-López Remedios Giner-Durán Desamparados Escudero-García Miguel Angel Serra Emilio Soria Vicente Felipo Carmina Montoliu The PHES battery does not detect all cirrhotic patients with early neurological deficits, which are different in different patients. PLoS ONE |
| title | The PHES battery does not detect all cirrhotic patients with early neurological deficits, which are different in different patients. |
| title_full | The PHES battery does not detect all cirrhotic patients with early neurological deficits, which are different in different patients. |
| title_fullStr | The PHES battery does not detect all cirrhotic patients with early neurological deficits, which are different in different patients. |
| title_full_unstemmed | The PHES battery does not detect all cirrhotic patients with early neurological deficits, which are different in different patients. |
| title_short | The PHES battery does not detect all cirrhotic patients with early neurological deficits, which are different in different patients. |
| title_sort | phes battery does not detect all cirrhotic patients with early neurological deficits which are different in different patients |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0171211&type=printable |
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