Validation of S-ANT for the diagnosis of minimal hepatic encephalopathy

Introduction and Objectives

Hepatic encephalopathy (HE) is one of the most frequent complications of cirrhosis, minimal hepatic encephalopathy (MHE) is the initial stage and is characterized by the fact that it has no clinical data, its diagnosis is made with neuropsychological tests, the MHE produces a deterioration in the quality of life of patients and an increased risk of accidents. Hence, it is relevant to diagnose. Performing neuropsychological tests requires prolonged time, so validating an MHE count test that is easy, reproducible, and in less time is recommended. The simplified-animal naming test (S-ANT) test is performed by asking the patient to nominate 20 animals in one minute. In the reference cutoff for the non-Mexican population, a score lower than 15 suggests MHE.

We aimed to assess the validity of the S-ANT scale as a screening test in patients with cirrhosis without overt HE.

Materials and Patients

We present a prospective, descriptive, and analytical study of patients with cirrhosis of different etiology without overt HE who underwent S-ANT, PHES, and Flicker tests. We determine the area under the receiver operator characteristic (AUROC) curve to validate the S-ANT test. MHE was detected if the PHES and Flicker tests were abnormal.

We compared the S-ANT scores of both groups with and without MHE with the student's t-test for independent groups. Sensitivity (S) and specificity (SE) were calculated with the AUROC cutoff point for MHE.

Results

Detection of MHE was in 12/83 patients (14.5%); 43 (51.83%) women, mean age 52.7 ± 7.5 years, median schooling 8.3 years (range 0-17), the etiology of cirrhosis was: 39 (47.0%) alcohol, 9 (28.9%) primary biliary cirrhosis, 17 (20.5%) metabolic fatty liver, 18 (21.7%) hepatitis C virus According to Child-Pugh: 57 (68.7%) A, 25 (30.1%) B, and 1 (1.2%) C. The mean S-ANT for non-MHE was 19.35±5.4, and for MHE, 14.7±5.6, p=0.024 AUROC was significant .760 (.577- .942, 95%CI); p=0.037 with S=83% and SE=77% cutoff= 17.5 words, which is higher than for other populations.

Conclusions

In the Mexican population, S-ANT reliably discriminates against patients with cirrhosis without overt HE with cognitive impairment, confirmed by PHES and Flicker test

Ethical statement

The protocol was registered and approved by the Ethics Committee. The identity of the patients is protected. Consentment was obtained.

Declaration of interests

None

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.