Liver, Pancreas and Biliary TractBispectral index monitoring for diagnosis and assessment of severity of hepatic encephalopathy in cirrhotic patients

BackgroundRecent evidence suggests that bispectral index may aid in the diagnosis of hepatic encephalopathy. We evaluated its utility to diagnose, grade and monitor clinical course of hepatic encephalopathy in patients with cirrhosis.Methods200 patients (70.5% males, mean age 39.5 ± 9.1 years) with cirrhosis and 20 healthy controls were enrolled prospectively. Cirrhotic patients were divided into groups based on encephalopathy grades I-IV assessed by West Haven criteria; minimal encephalopathy was assessed by psychometric tests. Bispectral index was measured at baseline and after one week of lactulose therapy in patients with overt encephalopathy, and after 3 months in patients with minimal encephalopathy.ResultsBispectral index scores were significantly different in patients with different grades of encephalopathy; 79.5 ± 4.2, 67.5 ± 4.3, 56.4 ± 3.5, 44.8 ± 3.9 and 85.0 ± 4.3 respectively for grade I, II, III, IV overt and minimal hepatic encephalopathy, but similar (92.6 ± 3.7 vs 93.75 ± 2.8) in cirrhotics without encephalopathy and healthy controls. Bispectral scores' cut off values for minimal and overt encephalopathy grade I, II, III, IV were 90.5 and 77.5, 70.5, 60.5, 50.5, respectively. Changes in bispectral index after treatment corresponded to cut-off scores for grades of overt and minimal hepatic encephalopathy.ConclusionsBispectral index was found to be useful in diagnosis, grading and monitoring of treatment response in cirrhotic patients with hepatic encephalopathy.