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The mind and liver test: a new approach to the diagnosis of minimal hepatic encephalopathy in resource-poor settings.

Das S, Ali SM, Seward J, Venkataraman J - Int J Hepatol (2014)

Bottom Line: Results.Test-retest agreement was high (ICC = 0.89).Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Gastroenterology, Stanley Medical College and Hospital, Chennai 600001, India.

ABSTRACT
Background and Aims. Minimal hepatic encephalopathy (MHE) is diagnosed using neuropsychometric tests or neurophysiological tests that are either inapplicable to illiterate patient population in resource-poor settings or require sophisticated and expensive equipment. The available tests assess discrete domains of mental impairment. Our aim was (a) to design a neuropsychometric test that measures all domains of mental impairment in MHE using one metric; (b) to evaluate its sensitivity, specificity, and reproducibility. Methods. The mind and liver test (MALT), a psychometric test assessing cognition, memory, and psychometric impairment, each on a scale of 20, was designed keeping in mind the requirements of a universal test. 40 cirrhotics and 36 controls were subjected to critical flicker frequency (CFF) and MALT in same sitting. ROC curve was plotted for MALT using CFF as gold standard. Bland-Altman plot was used to find test-retest agreement. Results. CFF values and MALT scores varied significantly between the cases and the controls (P < 0.05). MALT was 94% sensitive and 83% specific. Using ROC with CFF as gold standard, the AUC for diagnosis of MHE using MALT score was 0.89. Test-retest agreement was high (ICC = 0.89). Conclusion. In this pilot study, MALT proved to be highly sensitive, specific, inexpensive, and reproducible.

No MeSH data available.


Related in: MedlinePlus

(a) ROC curve using CFF as gold standard and MALT score 20 as cut-off for the diagnosis of MHE. (b) Bland-Altman plot for the test-retest agreement of MALT.
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fig4: (a) ROC curve using CFF as gold standard and MALT score 20 as cut-off for the diagnosis of MHE. (b) Bland-Altman plot for the test-retest agreement of MALT.

Mentions: The cases performed worse than controls on MALT. The controls scored 10 ± 5 compared to the cases, who scored 18 ± 8 (Figure 3(b)). This difference was significant (P = 0.00). On plotting the ROC curve (Figure 4(a)), the sensitivity and the specificity were found to be 94% and 83%, respectively, for a cut-off value set at 20. Using ROC with CFF as the gold standard, the AUC for diagnosis of MHE using MALT score was 89%. Figure 3(b) compares the mean MALT scores of MHE, non-MHE cirrhotics, and controls. MHE patients scored higher than the non-MHE and controls using the 20 mark as cut-off.


The mind and liver test: a new approach to the diagnosis of minimal hepatic encephalopathy in resource-poor settings.

Das S, Ali SM, Seward J, Venkataraman J - Int J Hepatol (2014)

(a) ROC curve using CFF as gold standard and MALT score 20 as cut-off for the diagnosis of MHE. (b) Bland-Altman plot for the test-retest agreement of MALT.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4274711&req=5

fig4: (a) ROC curve using CFF as gold standard and MALT score 20 as cut-off for the diagnosis of MHE. (b) Bland-Altman plot for the test-retest agreement of MALT.
Mentions: The cases performed worse than controls on MALT. The controls scored 10 ± 5 compared to the cases, who scored 18 ± 8 (Figure 3(b)). This difference was significant (P = 0.00). On plotting the ROC curve (Figure 4(a)), the sensitivity and the specificity were found to be 94% and 83%, respectively, for a cut-off value set at 20. Using ROC with CFF as the gold standard, the AUC for diagnosis of MHE using MALT score was 89%. Figure 3(b) compares the mean MALT scores of MHE, non-MHE cirrhotics, and controls. MHE patients scored higher than the non-MHE and controls using the 20 mark as cut-off.

Bottom Line: Results.Test-retest agreement was high (ICC = 0.89).Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Gastroenterology, Stanley Medical College and Hospital, Chennai 600001, India.

ABSTRACT
Background and Aims. Minimal hepatic encephalopathy (MHE) is diagnosed using neuropsychometric tests or neurophysiological tests that are either inapplicable to illiterate patient population in resource-poor settings or require sophisticated and expensive equipment. The available tests assess discrete domains of mental impairment. Our aim was (a) to design a neuropsychometric test that measures all domains of mental impairment in MHE using one metric; (b) to evaluate its sensitivity, specificity, and reproducibility. Methods. The mind and liver test (MALT), a psychometric test assessing cognition, memory, and psychometric impairment, each on a scale of 20, was designed keeping in mind the requirements of a universal test. 40 cirrhotics and 36 controls were subjected to critical flicker frequency (CFF) and MALT in same sitting. ROC curve was plotted for MALT using CFF as gold standard. Bland-Altman plot was used to find test-retest agreement. Results. CFF values and MALT scores varied significantly between the cases and the controls (P < 0.05). MALT was 94% sensitive and 83% specific. Using ROC with CFF as gold standard, the AUC for diagnosis of MHE using MALT score was 0.89. Test-retest agreement was high (ICC = 0.89). Conclusion. In this pilot study, MALT proved to be highly sensitive, specific, inexpensive, and reproducible.

No MeSH data available.


Related in: MedlinePlus