Description:
<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>The psychometric hepatic encephalopathy score (<jats:styled-content style="fixed-case">PHES</jats:styled-content>) is recommended as a gold standard in evaluation of minimal hepatic encephalopathy (<jats:styled-content style="fixed-case">HE</jats:styled-content>). Normative databases have been collected in few countries, clearly showing differences among studied groups. Thus, the standardization of <jats:styled-content style="fixed-case">PHES</jats:styled-content> for selected populations remains necessary.</jats:p></jats:sec><jats:sec><jats:title>Aims</jats:title><jats:p>To standardize <jats:styled-content style="fixed-case">PHES</jats:styled-content> in a large cohort of Polish healthy subjects and to evaluate the normograms in patients with cirrhosis with quantified electroencephalography (<jats:styled-content style="fixed-case">EEG</jats:styled-content>).</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Three hundred and sixteen (142 males/174 females, aged 44.5 ± 12.1) normal individuals and 50 (31 males/19 females, aged 52.8 ± 12.4) patients with cirrhosis without overt <jats:styled-content style="fixed-case">HE</jats:styled-content> were included. Key correction variables of psychometric tests were performed. The multivariate linear regression was used to calculate <jats:styled-content style="fixed-case">PHES</jats:styled-content> normograms.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Age and education levels were identified as predictors of all tests, therefore age‐ and education‐adjusted normograms were developed. A weighted time‐errors regression model for line tracing test (<jats:styled-content style="fixed-case">LTT</jats:styled-content>) scoring was used. The <jats:styled-content style="fixed-case">PHES</jats:styled-content> ranged between +5 and −15 points and the cut‐off between normal and pathological <jats:styled-content style="fixed-case">PHES</jats:styled-content> was set on ≤−5 points. By this cut‐off level, <jats:styled-content style="fixed-case">PHES</jats:styled-content> had a sensitivity of 57% and specificity of 97% to diagnose minimal <jats:styled-content style="fixed-case">HE</jats:styled-content> (<jats:styled-content style="fixed-case">AUC</jats:styled-content> = 0.866 ± 0.028). In patients with cirrhosis, <jats:styled-content style="fixed-case">PHES</jats:styled-content> correlated with severity of liver disease (<jats:styled-content style="fixed-case">MELD</jats:styled-content>,<jats:italic> r = −</jats:italic>0.475, <jats:italic>P </jats:italic><<jats:italic> </jats:italic>0.001 and Child–Pugh classification, <jats:italic>r = −</jats:italic>0.452, <jats:italic>P </jats:italic><<jats:italic> </jats:italic>0.002) and <jats:styled-content style="fixed-case">EEG</jats:styled-content> (<jats:italic>r </jats:italic>=<jats:italic> </jats:italic>0.547, <jats:italic>P </jats:italic><<jats:italic> </jats:italic>0.002). In patients with impaired <jats:styled-content style="fixed-case">EEG</jats:styled-content>,<jats:styled-content style="fixed-case"> PHES</jats:styled-content> was lower than in individuals with unaltered <jats:styled-content style="fixed-case">EEG</jats:styled-content> (<jats:italic>P </jats:italic><<jats:italic> </jats:italic>0.02); however, agreement between these two modalities was limited.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Valid Polish <jats:styled-content style="fixed-case">PHES</jats:styled-content> normograms, which incorporates w‐<jats:styled-content style="fixed-case">LTT</jats:styled-content> scoring system have been developed. Future multi‐centre international studies are needed to validate widely applicable norms.</jats:p></jats:sec>