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Validation of the simplified Animal Naming Test as primary screening tool for the diagnosis of covert hepatic encephalopathy

  • Christian Labenz
    Affiliations
    Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany

    Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
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  • Larissa Beul
    Affiliations
    Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany

    Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
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  • Gerrit Toenges
    Affiliations
    Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
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  • Jörn M. Schattenberg
    Affiliations
    Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany

    Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
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  • Michael Nagel
    Affiliations
    Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany

    Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
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  • Martin F. Sprinzl
    Affiliations
    Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany

    Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
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  • Marc Nguyen-Tat
    Affiliations
    Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany

    Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
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  • Tim Zimmermann
    Affiliations
    Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany

    Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
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  • Yvonne Huber
    Affiliations
    Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany

    Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
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  • Jens U. Marquardt
    Affiliations
    Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany

    Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
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  • Peter R. Galle
    Affiliations
    Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany

    Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
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  • Marcus-Alexander Wörns
    Correspondence
    Corresponding author at: Department of Internal Medicine I, Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Langenbeckstraße 1, 55101 Mainz, Germany.
    Affiliations
    Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany

    Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
    Search for articles by this author
Published:August 19, 2018DOI:https://doi.org/10.1016/j.ejim.2018.08.008

      Abstract

      Background

      Diagnosis of covert hepatic encephalopathy (CHE) is time consuming in clinical practice. Recently, a new diagnostic tool - the simplified Animal Naming Test (S-ANT1) - was presented with promising results in an Italian cohort. The aim of the present study was to validate S-ANT1 in a cohort of cirrhotic patients from a German tertiary referral centre.

      Methods

      143 cirrhotic patients and 37 healthy controls were enrolled. Hepatic encephalopathy (HE) grade 1 (HE1) was clinically diagnosed according to the West-Haven Criteria. Critical flicker frequency and Psychometric Hepatic Encephalopathy Score were used to detect minimal HE (MHE). All participants were additionally examined by S-ANT1.

      Results

      58 (40.6%) patients presented with CHE (40 MHE, 18 HE1). S-ANT1 was lowest in patients with HE1, followed by patients with MHE, patients without CHE, and healthy controls, respectively (each p < 0.05). Naming <20 animals discriminated best between patients with and without CHE in ROC analysis (with Youden's index). With a cut-off value of ≥23 mentioned animal names further testing for CHE could be avoided in 38.5% of patients with a negative predictive value of 84%.

      Conclusions

      S-ANT1 may become an important first screening tool for the assessment of CHE in clinical practice.

      Keywords

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