Use of Psycometric tests, Critical flicker frequency test and comparative evaluation of inflammation indicators in the diagnosis of covert hepatic encephalopathy

INTRODUCTION: Hepatic encephalopathy (HE) is one of the major and frequent complications of liver diseases. HE comprises of 2 clinical patterns: Covert hepatic encephalopathy(CHE) and Overt hepatic encephalopathy (OHE). The lack of clinical signs makes CHE hard to diagnose and carrying risk to progress into OHE is vital. CHE is important to diagnose, even to interfere. Given the lack of diagnostic measures to use, we wanted to search the optimal diagnostic tool. METHODS: In this study we evaluated cirrhotic patients, divided into two categories (cirrhotic patients with CHE and cirrotic patients without CHE) by using West Haven Criteria and compared them to healthy controls. We applied psychometric hepatic encephalopathy score (PHES) and Critical flicker frequency (CFF) test for both patient and control groups and took blood samples to measure plasma ammonia, serum 3-nitro tyrosine (3-NT), endotoxin, interleukin 6 (IL-6) and 18, tumor necrosis factor alpha (TNF-α) levels, prospectively.  RESULTS: There were 40 female, 36 male cirrhotic patients and 13 healthy controls (6F, 7M). Twenty-one of females and 20 of males were diagnosed as CHE; 19 female and 16 male cirrhotics did not have CHE by using West Haven criteria. When CFF test was applied to patients and healthy volunteers, patients with CHE clinic according to West-Haven criteria, completed by reacting late compared to non-CHE patients (pCONCLUSION: CFF and PHES tests are still gold standart (maybe except NCT) to detect CHE cirrhotic patients. Besides these tests; IL-6, TNF-α, endotoxin and probably 3-NT levels could be used for detecting CHE patients.