Animal naming test for the assessment of minimal hepatic encephalopathy in Asian cirrhotic populations

Background and aim: To evaluate the diagnostic performance of simplified animal naming test (S-ANT1) for minimal hepatic encephalopathy (MHE) in patients with cirrhosis from a Chinese tertiary centre and to optimize the application strategy of S-ANT1 in clinical practice. Methods: The Animal Naming Test 1 (ANT1) was performed in all included cirrhotic patients and healthy volunteers. S-ANT1 was calculated to adjust for age and education. Psychometric Hepatic Encephalopathy Score (PHES) was also performed in patients with cirrhosis. Results: 88 cirrhotic patients and 34 healthy control subjects were included. Cirrhotic patients were characterized with lower S-ANT1 scores (P = 0.001). In patients with cirrhosis, score of S-ANT1 was correlated with PHES score, age, school education period, and blood ammonia (all P values <0.05). With <20 animals as the cut-off value, S-ANT1 could distinguish MHE and no MHE with a sensitivity of 77.5% and a specificity of 58.3%. A three-step screening strategy, with 90% as a threshold for sensitivity and specificity and two cut-off values <12 animals and >23 animals, was then formulated to rule out patients with high possibility of MHE and with high possibility of no MHE. The remaining ruled-in patients should be further evaluated for MHE using PHES. Conclusions: S-ANT1 is an important screening tool for MHE in cirrhotic patients. The three step screening strategy based on S-ANT1 and PHES is conducive to the identification of MHE in clinical practice. (c) 2021 Elsevier Masson SAS. All rights reserved.

Automated summary

S-ANT1 is an important screening tool for MHE in cirrhotic patients. A three-step screening strategy based on S-ANT1 and PHES is conducive to the identification of MHE in clinical practice, providing sensitivity and specificity thresholds at 90%, and cut-off values to rule out or rule in patients for further evaluation.