A simple covert hepatic encephalopathy screening model based on blood biochemical parameters in patients with cirrhosis
Covert hepatic encephalopathy (CHE) adversely affects clinical outcomes in patients with liver cirrhosis, although its diagnosis is difficult. This study aimed to establish a simple CHE screening model based on blood-related biochemical parameters. This retrospective study enrolled 439 patients who...
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| Veröffentlicht in: | PloS one 2022-11, Vol.17 (11), p.e0277829-e0277829 |
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| creator | Miwa, Takao Hanai, Tatsunori Nishimura, Kayoko Maeda, Toshihide Tajirika, Satoko Imai, Kenji Suetsugu, Atsushi Takai, Koji Yamamoto, Mayumi Shimizu, Masahito |
| description | Covert hepatic encephalopathy (CHE) adversely affects clinical outcomes in patients with liver cirrhosis, although its diagnosis is difficult. This study aimed to establish a simple CHE screening model based on blood-related biochemical parameters.
This retrospective study enrolled 439 patients who were assessed for CHE using a neuropsychiatric test between January 2011 and June 2019. A simple CHE (sCHE) score was calculated with hypoalbuminemia (≤ 3.5 g/dL) and hyperammonemia (≥ 80 μg/dL) as 1 point each. The association between sCHE score and CHE or overt hepatic encephalopathy (OHE) was assessed using logistic regression and Fine-Gray competing risk regression models.
Of 381 eligible patients, 79 (21%) were diagnosed with CHE. The distribution of sCHE scores was 48% with 0 point, 33% with 1 point, and 19% with 2 points. Patients with sCHE score ≥ 1 point had a higher prevalence of CHE than those with sCHE score of 0 (27% vs. 14%, P = 0.002). A cut-off value of 1 point showed high discriminative ability for identifying CHE, with a sensitivity of 0.67, specificity of 0.56, positive predictive value of 0.27, and negative predictive value of 0.86. During the median follow-up period of 2.2 years, 58 (15%) patients developed OHE. Multivariate analysis showed that sCHE score ≥ 1 (sub-distribution hazard ratio [SHR], 2.69; 95% confidence interval [CI], 1.41-5.15) and CHE (SHR, 2.17; 95% CI, 1.26-3.73) independently predicted OHE.
The sCHE score is a useful screening model for identifying patients with CHE and for predicting OHE occurrence. |
| doi_str_mv | 10.1371/journal.pone.0277829 |
| format | Article |
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This retrospective study enrolled 439 patients who were assessed for CHE using a neuropsychiatric test between January 2011 and June 2019. A simple CHE (sCHE) score was calculated with hypoalbuminemia (≤ 3.5 g/dL) and hyperammonemia (≥ 80 μg/dL) as 1 point each. The association between sCHE score and CHE or overt hepatic encephalopathy (OHE) was assessed using logistic regression and Fine-Gray competing risk regression models.
Of 381 eligible patients, 79 (21%) were diagnosed with CHE. The distribution of sCHE scores was 48% with 0 point, 33% with 1 point, and 19% with 2 points. Patients with sCHE score ≥ 1 point had a higher prevalence of CHE than those with sCHE score of 0 (27% vs. 14%, P = 0.002). A cut-off value of 1 point showed high discriminative ability for identifying CHE, with a sensitivity of 0.67, specificity of 0.56, positive predictive value of 0.27, and negative predictive value of 0.86. During the median follow-up period of 2.2 years, 58 (15%) patients developed OHE. Multivariate analysis showed that sCHE score ≥ 1 (sub-distribution hazard ratio [SHR], 2.69; 95% confidence interval [CI], 1.41-5.15) and CHE (SHR, 2.17; 95% CI, 1.26-3.73) independently predicted OHE.
The sCHE score is a useful screening model for identifying patients with CHE and for predicting OHE occurrence.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0277829</identifier><identifier>PMID: 36449492</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Ammonia ; Biology and Life Sciences ; Blood ; Cirrhosis ; Clinical outcomes ; Confidence intervals ; Diagnosis ; Encephalopathy ; Health risks ; Hepatic encephalopathy ; Hepatic Encephalopathy - diagnosis ; Humans ; Hyperammonemia ; Liver ; Liver cancer ; Liver cirrhosis ; Liver Cirrhosis - complications ; Liver Cirrhosis - diagnosis ; Liver diseases ; Medical examination ; Medical screening ; Medicine and Health Sciences ; Methods ; Modelling ; Multivariate analysis ; Parameters ; Patients ; Physical Sciences ; Regression analysis ; Regression models ; Research and Analysis Methods ; Retrospective Studies ; Statistical analysis ; Statistical significance ; Variables</subject><ispartof>PloS one, 2022-11, Vol.17 (11), p.e0277829-e0277829</ispartof><rights>Copyright: © 2022 Miwa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</rights><rights>COPYRIGHT 2022 Public Library of Science</rights><rights>2022 Miwa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2022 Miwa et al 2022 Miwa et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-d0360c973f9eae4031236a340d74862ffd9b86e1508f57155472625ed7be623a3</citedby><cites>FETCH-LOGICAL-c692t-d0360c973f9eae4031236a340d74862ffd9b86e1508f57155472625ed7be623a3</cites><orcidid>0000-0002-6373-260X ; 0000-0002-5603-6825 ; 0000-0001-7797-9534</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9710772/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9710772/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2095,2914,23846,27903,27904,53770,53772,79347,79348</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36449492$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Mori, Shunsuke</contributor><creatorcontrib>Miwa, Takao</creatorcontrib><creatorcontrib>Hanai, Tatsunori</creatorcontrib><creatorcontrib>Nishimura, Kayoko</creatorcontrib><creatorcontrib>Maeda, Toshihide</creatorcontrib><creatorcontrib>Tajirika, Satoko</creatorcontrib><creatorcontrib>Imai, Kenji</creatorcontrib><creatorcontrib>Suetsugu, Atsushi</creatorcontrib><creatorcontrib>Takai, Koji</creatorcontrib><creatorcontrib>Yamamoto, Mayumi</creatorcontrib><creatorcontrib>Shimizu, Masahito</creatorcontrib><title>A simple covert hepatic encephalopathy screening model based on blood biochemical parameters in patients with cirrhosis</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Covert hepatic encephalopathy (CHE) adversely affects clinical outcomes in patients with liver cirrhosis, although its diagnosis is difficult. This study aimed to establish a simple CHE screening model based on blood-related biochemical parameters.
This retrospective study enrolled 439 patients who were assessed for CHE using a neuropsychiatric test between January 2011 and June 2019. A simple CHE (sCHE) score was calculated with hypoalbuminemia (≤ 3.5 g/dL) and hyperammonemia (≥ 80 μg/dL) as 1 point each. The association between sCHE score and CHE or overt hepatic encephalopathy (OHE) was assessed using logistic regression and Fine-Gray competing risk regression models.
Of 381 eligible patients, 79 (21%) were diagnosed with CHE. The distribution of sCHE scores was 48% with 0 point, 33% with 1 point, and 19% with 2 points. Patients with sCHE score ≥ 1 point had a higher prevalence of CHE than those with sCHE score of 0 (27% vs. 14%, P = 0.002). A cut-off value of 1 point showed high discriminative ability for identifying CHE, with a sensitivity of 0.67, specificity of 0.56, positive predictive value of 0.27, and negative predictive value of 0.86. During the median follow-up period of 2.2 years, 58 (15%) patients developed OHE. Multivariate analysis showed that sCHE score ≥ 1 (sub-distribution hazard ratio [SHR], 2.69; 95% confidence interval [CI], 1.41-5.15) and CHE (SHR, 2.17; 95% CI, 1.26-3.73) independently predicted OHE.
The sCHE score is a useful screening model for identifying patients with CHE and for predicting OHE occurrence.</description><subject>Ammonia</subject><subject>Biology and Life Sciences</subject><subject>Blood</subject><subject>Cirrhosis</subject><subject>Clinical outcomes</subject><subject>Confidence intervals</subject><subject>Diagnosis</subject><subject>Encephalopathy</subject><subject>Health risks</subject><subject>Hepatic encephalopathy</subject><subject>Hepatic Encephalopathy - diagnosis</subject><subject>Humans</subject><subject>Hyperammonemia</subject><subject>Liver</subject><subject>Liver cancer</subject><subject>Liver cirrhosis</subject><subject>Liver Cirrhosis - complications</subject><subject>Liver Cirrhosis - diagnosis</subject><subject>Liver diseases</subject><subject>Medical examination</subject><subject>Medical screening</subject><subject>Medicine and Health Sciences</subject><subject>Methods</subject><subject>Modelling</subject><subject>Multivariate analysis</subject><subject>Parameters</subject><subject>Patients</subject><subject>Physical Sciences</subject><subject>Regression analysis</subject><subject>Regression models</subject><subject>Research and Analysis Methods</subject><subject>Retrospective Studies</subject><subject>Statistical analysis</subject><subject>Statistical 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simple covert hepatic encephalopathy screening model based on blood biochemical parameters in patients with cirrhosis</title><author>Miwa, Takao ; Hanai, Tatsunori ; Nishimura, Kayoko ; Maeda, Toshihide ; Tajirika, Satoko ; Imai, Kenji ; Suetsugu, Atsushi ; Takai, Koji ; Yamamoto, Mayumi ; Shimizu, Masahito</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-d0360c973f9eae4031236a340d74862ffd9b86e1508f57155472625ed7be623a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Ammonia</topic><topic>Biology and Life Sciences</topic><topic>Blood</topic><topic>Cirrhosis</topic><topic>Clinical outcomes</topic><topic>Confidence intervals</topic><topic>Diagnosis</topic><topic>Encephalopathy</topic><topic>Health risks</topic><topic>Hepatic encephalopathy</topic><topic>Hepatic Encephalopathy - diagnosis</topic><topic>Humans</topic><topic>Hyperammonemia</topic><topic>Liver</topic><topic>Liver cancer</topic><topic>Liver cirrhosis</topic><topic>Liver Cirrhosis - complications</topic><topic>Liver Cirrhosis - diagnosis</topic><topic>Liver diseases</topic><topic>Medical examination</topic><topic>Medical screening</topic><topic>Medicine and Health Sciences</topic><topic>Methods</topic><topic>Modelling</topic><topic>Multivariate analysis</topic><topic>Parameters</topic><topic>Patients</topic><topic>Physical Sciences</topic><topic>Regression analysis</topic><topic>Regression models</topic><topic>Research and Analysis Methods</topic><topic>Retrospective Studies</topic><topic>Statistical analysis</topic><topic>Statistical significance</topic><topic>Variables</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Miwa, Takao</creatorcontrib><creatorcontrib>Hanai, Tatsunori</creatorcontrib><creatorcontrib>Nishimura, 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Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Miwa, Takao</au><au>Hanai, Tatsunori</au><au>Nishimura, Kayoko</au><au>Maeda, Toshihide</au><au>Tajirika, Satoko</au><au>Imai, Kenji</au><au>Suetsugu, Atsushi</au><au>Takai, Koji</au><au>Yamamoto, Mayumi</au><au>Shimizu, Masahito</au><au>Mori, Shunsuke</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A simple covert hepatic encephalopathy screening model based on blood biochemical parameters in patients with cirrhosis</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2022-11-30</date><risdate>2022</risdate><volume>17</volume><issue>11</issue><spage>e0277829</spage><epage>e0277829</epage><pages>e0277829-e0277829</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Covert hepatic encephalopathy (CHE) adversely affects clinical outcomes in patients with liver cirrhosis, although its diagnosis is difficult. This study aimed to establish a simple CHE screening model based on blood-related biochemical parameters.
This retrospective study enrolled 439 patients who were assessed for CHE using a neuropsychiatric test between January 2011 and June 2019. A simple CHE (sCHE) score was calculated with hypoalbuminemia (≤ 3.5 g/dL) and hyperammonemia (≥ 80 μg/dL) as 1 point each. The association between sCHE score and CHE or overt hepatic encephalopathy (OHE) was assessed using logistic regression and Fine-Gray competing risk regression models.
Of 381 eligible patients, 79 (21%) were diagnosed with CHE. The distribution of sCHE scores was 48% with 0 point, 33% with 1 point, and 19% with 2 points. Patients with sCHE score ≥ 1 point had a higher prevalence of CHE than those with sCHE score of 0 (27% vs. 14%, P = 0.002). A cut-off value of 1 point showed high discriminative ability for identifying CHE, with a sensitivity of 0.67, specificity of 0.56, positive predictive value of 0.27, and negative predictive value of 0.86. During the median follow-up period of 2.2 years, 58 (15%) patients developed OHE. Multivariate analysis showed that sCHE score ≥ 1 (sub-distribution hazard ratio [SHR], 2.69; 95% confidence interval [CI], 1.41-5.15) and CHE (SHR, 2.17; 95% CI, 1.26-3.73) independently predicted OHE.
The sCHE score is a useful screening model for identifying patients with CHE and for predicting OHE occurrence.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>36449492</pmid><doi>10.1371/journal.pone.0277829</doi><tpages>e0277829</tpages><orcidid>https://orcid.org/0000-0002-6373-260X</orcidid><orcidid>https://orcid.org/0000-0002-5603-6825</orcidid><orcidid>https://orcid.org/0000-0001-7797-9534</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | PloS one, 2022-11, Vol.17 (11), p.e0277829-e0277829 |
| issn | 1932-6203 1932-6203 |
| language | eng |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Public Library of Science (PLoS); PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Ammonia Biology and Life Sciences Blood Cirrhosis Clinical outcomes Confidence intervals Diagnosis Encephalopathy Health risks Hepatic encephalopathy Hepatic Encephalopathy - diagnosis Humans Hyperammonemia Liver Liver cancer Liver cirrhosis Liver Cirrhosis - complications Liver Cirrhosis - diagnosis Liver diseases Medical examination Medical screening Medicine and Health Sciences Methods Modelling Multivariate analysis Parameters Patients Physical Sciences Regression analysis Regression models Research and Analysis Methods Retrospective Studies Statistical analysis Statistical significance Variables |
| title | A simple covert hepatic encephalopathy screening model based on blood biochemical parameters in patients with cirrhosis |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-23T08%3A03%3A33IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=A%20simple%20covert%20hepatic%20encephalopathy%20screening%20model%20based%20on%20blood%20biochemical%20parameters%20in%20patients%20with%20cirrhosis&rft.jtitle=PloS%20one&rft.au=Miwa,%20Takao&rft.date=2022-11-30&rft.volume=17&rft.issue=11&rft.spage=e0277829&rft.epage=e0277829&rft.pages=e0277829-e0277829&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0277829&rft_dat=%3Cgale_plos_%3EA728371638%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2743380986&rft_id=info:pmid/36449492&rft_galeid=A728371638&rft_doaj_id=oai_doaj_org_article_35c9a0c6298e4c198e12f0c5a25d0cae&rfr_iscdi=true |