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Auditory and visual P300 event-related potentials to detect minimal hepatic encephalopathy
Ángel Daniel Santana-Vargas1, Fátima Higuera-De la Tijera2, José Luis Pérez-Hernández3
1Research, Hospital General de México Dr. Eduardo Liceaga, México.
Introduction:
the diagnosis of minimal hepatic encephalopathy (MHE) requires psychometric tests, although new methods are needed since their sensitivity, specificity, and accuracy are low. The P300 event-related potential (ERP) is obtained by auditory and visual stimuli, although only the auditory P300 has been used to detect MHE. This study aimed to compare the diagnostic features of auditory and visual P300 to detect MHE.
Materials And Methods:
sixty patients with liver cirrhosis and thirty-five healthy controls completed the Psychometric Hepatic Encephalopathy Score (PHES), the critical flicker frequency (CFF), and auditory and visual P300 tests. MHE was diagnosed if PHES and CFF scores were abnormal.
Results:
fifty-three cirrhotic patients (aged 54.5 ± 8.6 years) completed all tests. Abnormal scores were obtained for PHES (49.1 %) and CFF (67.9 %). The proportion of MHE was 21.4 %. The area under the receiver operating (ROC) curves (AUROC) for auditory P300 was better than for visual P300 for distinguishing MHE from controls (AUROC: 0.792 vs 0.725; p < 0.005 for both; accuracy: 73.8 % vs 70.2 %; sensitivity: 72.2 % for both; specificity: 74.2 vs 69.7, respectively). Among cirrhotic patients, only auditory P300 was useful to detect MHE (AUROC: 0.723; p < 0.05; 77.4 % accuracy; 61.1 % sensitivity, and 81.8 % specificity).
Conclusions:
auditory P300 sensitivity, specificity, and accuracy were similar to those of CFF. Our results showed that only auditory P300 is useful to differentiate patients with MHE, although both modalities, auditory and visual, differentiated patients with cirrhosis from controls. Thus, we consider that visual P300 is not suitable for detecting MHE.
Insights
Auditory P300 event-related potential (ERP) shows promise for diagnosing minimal hepatic encephalopathy (MHE). Visual P300 ERP is not suitable for MHE detection, though both modalities differentiate cirrhosis patients from controls.
Area of Science:
- Neuroscience
- Gastroenterology
- Medical Diagnostics
Background:
- Current diagnosis of minimal hepatic encephalopathy (MHE) relies on psychometric tests with low sensitivity and specificity.
- Novel diagnostic methods are required to improve MHE detection accuracy.
- P300 event-related potential (ERP) is an electrophysiological measure, with auditory P300 previously explored for MHE.
Purpose of the Study:
- To compare the diagnostic capabilities of auditory and visual P300 event-related potentials (ERPs) for detecting minimal hepatic encephalopathy (MHE).
- To evaluate the utility of P300 ERPs in differentiating MHE patients from healthy controls and from cirrhotic patients without MHE.
Main Methods:
- Sixty patients with liver cirrhosis and 35 healthy controls underwent psychometric testing (PHES), critical flicker frequency (CFF), and auditory/visual P300 ERP tests.
- MHE diagnosis was based on abnormal PHES and CFF scores.
- Receiver operating characteristic (ROC) curve analysis was used to assess diagnostic performance.
Main Results:
- Auditory P300 demonstrated superior diagnostic performance compared to visual P300 in distinguishing MHE from controls (AUROC 0.792 vs 0.725).
- Among cirrhotic patients, only auditory P300 effectively differentiated MHE (AUROC 0.723, 77.4% accuracy).
- Auditory P300 sensitivity and specificity were comparable to critical flicker frequency (CFF).
Conclusions:
- Auditory P300 is a potentially useful tool for detecting minimal hepatic encephalopathy (MHE), offering comparable performance to CFF.
- Visual P300 ERP is not suitable for MHE detection.
- Both auditory and visual P300 ERPs can differentiate patients with cirrhosis from healthy controls.
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