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Sensitivity and specificity of bispectral index for classification of overt hepatic encephalopathy. A multicentre, observer-blinded, validation study
  1. Ashraf A Dahaba (ashraf.dahaba{at}meduni-graz.at)
  1. Graz Medical University, Austria
    1. Harald C Worm
    1. Graz Medical University, Austria
      1. Sheng-mei Zhu
      1. Zhe Jiang University First Hospital, China
        1. Fang-ping Bao
        1. Zhe Jiang University First Hospital, China
          1. Ayman Salah
          1. Kasr El-Aini Cairo University, Egypt
            1. Serag Zakaria
            1. Kasr El-Aini Cairo University, Egypt
              1. Helmar Bornemann
              1. Graz Medical University, Austria
                1. Vanessa Stadlbauer
                1. Graz Medical University, Austria
                  1. Peter H Rehak, Prof.
                  1. Graz Medical University, Austria
                    1. Helfried Metzler
                    1. Graz Medical University, Austria
                      1. Rudolf E Stauber
                      1. Graz Medical University, Austria

                        Abstract

                        Objective: The severity of hepatic encephalopathy is currently graded clinically using West Haven criteria and psychometric tests. The aim of the study was 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: Graz Medical University (Graz, Austria), Zhe Jiang First University Hospital (Hang Zhou, China), Cairo University (Cairo, Egypt).

                        Patients: Twenty-eight consecutive hepatic encephalopathy patients were first enrolled at Graz Medical University as a test set. The estimated BIS cut-off values were subsequently tested in a validation set of 31 patients at Zhe Jiang First University Hospital and 26 patients at Cairo University. Furthermore, 18 patients were reassessed at a later time point in a longitudinal study. Fifteen patients (15/85, 18%) were excluded from the final analysis: 11 agitated patients due to high electromyographic activity and 4 patients who 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 40/46 (87%) of the validation patients, and in 16/18 (89%) of the follow up patients. 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: Our study demonstrates that BIS is a useful measure for grading and monitoring the degree of involvement of central nervous system in patients with chronic liver disease.

                        • West Haven criteria
                        • diagnostic accuracy
                        • hepatic encephalopathy
                        • sensitivity
                        • specificity

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