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Validation of the animal naming test for diagnosing minimal hepatic encephalopathy
A D Cano-Contreras1, J A Velarde-Ruiz Velasco2, F Higuera-de-la-Tijera3
1Instituto de Investigaciones Médico-Biológicas, Universidad Veracruzana, Veracruz, Mexico.
Introduction And Aim:
The diagnosis of minimal hepatic encephalopathy (MHE) is complex in clinical practice, given that its adequate evaluation is time-consuming. The animal naming test (ANT1) has proven to be a useful tool for rapid MHE identification. Our aim was to validate the ANT1 in a cohort of Mexican patients with cirrhosis of the liver.
Material And Methods:
An observational, cross-sectional, and analytic study was conducted within the time frame of June 2022 and May 2023. MHE diagnosis was made using the psychometric hepatic encephalopathy score (PHES). Patients with overt HE evaluated through the West Haven criteria were excluded. The ANT1 was performed on all participants.
Results:
A total of 199 patients with cirrhosis and 31 non-cirrhotic control subjects were analyzed. Women predominated (61.8% and 71%) and mean patient age was 55 ± 10 and 53.6 ± 12 (range 19-84 years), respectively. Ninety patients (45.2%) met the MHE criteria determined by the PHES. Using an ANT1 cutoff point of ≤15, MHE was identified in 65 (32.7%) patients, along with 75% sensitivity, 72% specificity, 53% positive predictive value, 87% negative predictive value, and 73% diagnostic accuracy. The area under the curve for diagnosing MHE was 0.763 (standard error, 0.081; 95% confidence interval, 0.604-0.923; p ≤ 0.0001).
Conclusions:
The ANT1 was shown to be a useful tool for identifying MHE in daily clinical practice. In our population, a cutoff point ≤15 animals named could be utilized for rapid screening of patients at high risk for progressing to overt HE, who would then require extensive testing.
Insights
The animal naming test (ANT1) effectively identifies minimal hepatic encephalopathy (MHE) in Mexican cirrhosis patients. A cutoff of ≤15 animals named aids rapid screening for MHE, a condition complex to diagnose.
Area of Science:
- Hepatology
- Neuroscience
- Clinical Diagnostics
Background:
- Minimal hepatic encephalopathy (MHE) diagnosis is challenging and time-consuming in clinical practice.
- The animal naming test (ANT1) offers a rapid method for MHE identification.
Purpose of the Study:
- To validate the utility of the ANT1 for diagnosing MHE in a Mexican cohort of patients with liver cirrhosis.
- To establish a reliable cutoff point for ANT1 in this population.
Main Methods:
- An observational, cross-sectional study included 199 cirrhosis patients and 31 controls.
- MHE diagnosis was confirmed using the psychometric hepatic encephalopathy score (PHES).
- The ANT1 was administered to all participants, excluding those with overt hepatic encephalopathy.
Main Results:
- Ninety patients (45.2%) were diagnosed with MHE based on PHES.
- The ANT1, with a cutoff of ≤15 animals named, identified MHE in 32.7% of patients.
- The ANT1 demonstrated 75% sensitivity, 72% specificity, and 73% diagnostic accuracy (AUC=0.763).
Conclusions:
- The ANT1 is a valuable tool for MHE identification in routine clinical settings.
- A cutoff of ≤15 animals named on the ANT1 can be used for rapid screening of high-risk patients.
- This screening helps identify individuals who may require further, more extensive testing for MHE.
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