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Sensitivity and specificity of bispectral index for classification of overt hepatic encephalopathy: a multicentre, observer blinded, validation study
  1. A A Dahaba1,
  2. H C Worm2,
  3. S M Zhu3,
  4. F P Bao3,
  5. A Salah4,
  6. S Zakaria4,
  7. H Bornemann1,
  8. V Stadlbauer5,
  9. P H Rehak6,
  10. H Metzler1,
  11. R E Stauber5
  1. 1
    Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
  2. 2
    Division of Nephrology and Haemodialysis, Department of Internal Medicine, Medical University of Graz, Graz, Austria
  3. 3
    Department of Anaesthesiology, Zhejiang University First Affiliated Hospital, Hang Zhou, People’s Republic of China
  4. 4
    Department of Hepatogastroenterology, Kasr El-Aini Cairo University, Cairo, Egypt
  5. 5
    Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
  6. 6
    Biomedical Engineering and Computing Unit, Department of Surgery, Medical University of Graz, Graz, Austria
  1. Dr Ashraf A Dahaba, Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 29, A-8036 Graz, Austria; ashraf.dahaba{at}meduni-graz.at

Abstract

Background: The severity of hepatic encephalopathy is currently graded clinically using West Haven criteria and psychometric tests.

Objective: To assess the discriminative power of the bispectral index (BIS) monitor to classify the degree and progression of hepatic encephalopathy.

Design: A consecutive, multicentre, observer blinded validation study.

Setting: Medical University of Graz (Graz, Austria), Zhejiang University First Affiliated Hospital (Hang Zhou, China), and Cairo University (Cairo, Egypt).

Patients: 28 consecutive patients with hepatic encephalopathy were first enrolled at Medical University of Graz as a test set. The estimated BIS cut off values were subsequently tested in a validation set of 31 patients at Zhejiang University First Affiliated Hospital and 26 patients at Cairo University; 18 patients were reassessed later in a longitudinal study. Fifteen of 85 patients (18%) were excluded from the final analysis (11 became too agitated with high electromyographic activity; four fell asleep during the recording).

Results: Applying the Austrian BIS cut off values of 85, 70, and 55 for discriminating West Haven grades 1 to 4 yielded agreement between BIS classification and West Haven grades in 40 of the 46 validation patients (87%), and in 16 of the 18 follow up patients (89%). Mean (SD) BIS values differed significantly between patients with West Haven grade 1 (90.2 (2.5)), grade 2 (78.4 (6.6)), grade 3 (63.2 (4.8)), and grade 4 (45.4 (5.0)).

Conclusions: BIS is a useful measure for grading and monitoring the degree of involvement of the central nervous system in patients with chronic liver disease.

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Footnotes

  • Competing interests: None declared

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