Animal Naming Test Can Identify Covert Hepatic Encephalopathy in Patients With Cirrhosis With Limited Influence From...

The usefulness of the animal naming test (ANT) in identifying covert hepatic encephalopathy (CHE) is limited because adjustments for age and educational level are necessary. This study aimed to validate the ANT in Japanese patients with cirrhosis and to clarify whether such adjustments affect diagnostic performance.

This multicenter cross-sectional study included Japanese patients with cirrhosis and healthy controls. Independent CHE factors were assessed using a logistic regression model, and the discriminative ability of the ANT alone versus an adjusted model was compared using the area under the receiver-operating characteristic curve (AUC).

Among the 152 patients with cirrhosis and 56 controls, propensity score matching identified 43 individuals in each group. Patients with CHE had the lowest ANT scores, followed by those without CHE and healthy controls (14 vs. 17 vs. 19). A multivariable analysis showed that the ANT was an independent factor for identifying CHE (odds ratio, 0.88; 95% confidence interval, 0.80-0.97; p = 0.009), whereas age and educational level were not. The AUC for the ANT alone in CHE diagnosis was comparable to that for the adjusted model using age and educational level (0.68 vs. 0.71; p = 0.350). ANT performance was not influenced by age or educational level among those with CHE. The ANT's optimal, rule-out, and rule-in cut-off values for identifying CHE were 15, 20, and 11, respectively.

The ANT can identify CHE in Japanese patients with cirrhosis, and adjustment for age and educational level has a limited influence on its diagnostic performance.

This study was registered in the University Hospital Medical Information Network (UMIN) Clinical Trials Registry (UMIN000046313).