Prospective comparative study of inhibitory control test and psychometric hepatic encephalopathy score for diagnosis and prognosis of minimal hepatic encephalopathy in cirrhotic patients in the <scp>I</scp>ndian subcontinent

Abstract

OBJECTIVE: This study aimed to determine the usefulness of inhibitory control test (ICT) for diagnosing minimal hepatic encephalopathy (MHE) in the Indian subcontinent and its correlation with the severity of liver disease and to determine its prognostic significance. METHODS: Two hundred patients with cirrhosis and 200 healthy controls were enrolled. Only patients were administered with psychometric hepatic encephalopathy score (PHES), while both patients and controls were subjected to ICT. MHE was diagnosed when PHES ≤ -5. ICT was considered abnormal when the numbers of ICT lures were ≥ 14. RESULTS: Overall, 135 (67.5%) patients had MHE. Mean ICT lures were higher in cirrhotic patients with MHE than those without MHE (17.27, 95% confidence interval [CI] 13.9-22.3 vs 8.79, 95% CI 6.8-12.60, P < 0.001). Target accuracy was lower in patients with MHE than in those without (84.35, 95% CI 78.5-89.8 vs 95.36, 95% CI 90.1-99.2, P < 0.001). ICT had a sensitivity of 92.6% and specificity of 78.5% with the area under the receiver operating characteristic curve of 0.855 (95% CI 0.791-0.920) for MHE. ICT was correlated with Child-Turcotte-Pugh class (P < 0.001) and the model for end-stage liver disease score (P < 0.001) and predicted the development of overt hepatic encephalopathy (OHE) and probable survival with excellent test-retest reliability. CONCLUSIONS: ICT is useful for diagnosing MHE in patients with cirrhosis. It is correlated with disease severity and predicts the development of OHE and probable survival with excellent test-retest reliability.