Bispectral index monitoring for diagnosis and assessment of severity of hepatic encephalopathy in cirrhotic patients.

Abstract

BACKGROUND:

Recent evidence suggests that bispectral index may aid in the diagnosis of hepatic encephalopathy. We evaluated its utility to diagnose, grade and monitor clinical course of hepatic encephalopathy in patients with cirrhosis.

METHODS:

200 patients (70.5% males, mean age 39.5±9.1 years) with cirrhosis and 20 healthy controls were enrolled prospectively. Cirrhotic patients were divided into groups based on encephalopathy grades I-IV assessed by West Haven criteria; minimal encephalopathy was assessed by psychometric tests. Bispectral index was measured at baseline and after one week of lactulose therapy in patients with overt encephalopathy, and after 3 months in patients with minimal encephalopathy.

RESULTS:

Bispectral index scores were significantly different in patients with different grades of encephalopathy; 79.5±4.2, 67.5±4.3, 56.4±3.5, 44.8±3.9 and 85.0±4.3 respectively for grade I, II, III, IV overt and minimal hepatic encephalopathy, but similar (92.6±3.7 vs 93.75±2.8) in cirrhotics without encephalopathy and healthy controls. Bispectral scores' cut off values for minimal and overt encephalopathy grade I, II, III, IV were 90.5 and 77.5, 70.5, 60.5, 50.5, respectively. Changes in bispectral index after treatment corresponded to cut-off scores for grades of overt and minimal hepatic encephalopathy.

CONCLUSIONS:

Bispectral index was found to be useful in diagnosis, grading and monitoring of treatment response in cirrhotic patients with hepatic encephalopathy.

• Authors: Amit Jindal, Barjesh Chander Sharma, Sanjeev Sachdeva, Rajiv Chawla, Siddharth Srivastava, Sudhir Maharshi
• Journal: Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver (Dig Liver Dis) Vol. 47 Issue 9 Pg. 769-74 (Sep 2015) ISSN: 1878-3562 [Electronic] Netherlands
• PMID: 26022229 (Publication Type: Journal Article)
• Copyright: Copyright © 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Chemical References

• Lactulose
• Ammonia

Topics

• Adult
• Ammonia (blood)
• Case-Control Studies
• Female
• Hepatic Encephalopathy (classification, diagnosis, drug therapy)
• Humans
• Lactulose (administration & dosage)
• Liver Cirrhosis (complications)
• Male
• Middle Aged
• Neuropsychological Tests
• Prospective Studies
• Psychometrics
• ROC Curve
• Severity of Illness Index