{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T20:05:05Z","timestamp":1791489905007,"version":"4.3.4"},"reference-count":41,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2016,7,7]],"date-time":"2016-07-07T00:00:00Z","timestamp":1467849600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2016,9]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The diagnosis of covert hepatic encephalopathy (<jats:styled-content style=\"fixed-case\">CHE<\/jats:styled-content>) by means of portosystemic encephalopathy syndrome (<jats:styled-content style=\"fixed-case\">PSE<\/jats:styled-content>) test is costly and therefore infrequently performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To determine the ability of critical flicker frequency (<jats:styled-content style=\"fixed-case\">CFF<\/jats:styled-content>) alone or in combination with laboratory findings, as an initial test to pre\u2010select which patients should undergo further testing for the diagnosis of covert hepatic encephalopathy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This single\u2010centre study included all patients with cirrhosis who underwent <jats:styled-content style=\"fixed-case\">PSE<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">CFF<\/jats:styled-content> in 2011. <jats:styled-content style=\"fixed-case\">CHE<\/jats:styled-content> was defined by abnormal <jats:styled-content style=\"fixed-case\">PSE<\/jats:styled-content> test. Logistic regression analysis was performed to identify predictors of <jats:styled-content style=\"fixed-case\">CHE<\/jats:styled-content>. <jats:styled-content style=\"fixed-case\">ROC<\/jats:styled-content> curves were used to identify cut\u2010offs of these independent predictors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>One hundred and seventeen patients were included. Seventy (60%) had <jats:styled-content style=\"fixed-case\">CHE<\/jats:styled-content> with a higher <jats:styled-content style=\"fixed-case\">MELD<\/jats:styled-content> [16 (<jats:styled-content style=\"fixed-case\">IQR<\/jats:styled-content> 13\u201321); <jats:italic>P<\/jats:italic>\u00a0=\u00a00.001] and lower <jats:styled-content style=\"fixed-case\">CFF<\/jats:styled-content> [38\u00a0Hz (<jats:styled-content style=\"fixed-case\">IQR<\/jats:styled-content> 36\u201341) <jats:italic>P<\/jats:italic>\u00a0=\u00a00.0011]. On multivariate analyses, <jats:styled-content style=\"fixed-case\">CFF<\/jats:styled-content> [<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 0.83 (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.74\u20130.94)] and <jats:styled-content style=\"fixed-case\">MELD<\/jats:styled-content> [<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 1.13 (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.04\u20131.22)] were identified as independent predictors of <jats:styled-content style=\"fixed-case\">CHE<\/jats:styled-content>. Sensitivity and specificity of a <jats:styled-content style=\"fixed-case\">CFF<\/jats:styled-content> cut\u2010off of 43\u00a0Hz was 93.5% and 42.9%, and for a <jats:styled-content style=\"fixed-case\">MELD<\/jats:styled-content> cut\u2010off of 24, it was 97.5% and 32.8% respectively. Most patients with a <jats:styled-content style=\"fixed-case\">MELD<\/jats:styled-content>\u2010Score &lt;24 and a <jats:styled-content style=\"fixed-case\">CFF<\/jats:styled-content> &gt;43\u00a0Hz did not have <jats:styled-content style=\"fixed-case\">CHE<\/jats:styled-content> (78%) and with a <jats:styled-content style=\"fixed-case\">MELD<\/jats:styled-content>\u2010Score &gt;24 and <jats:styled-content style=\"fixed-case\">CFF<\/jats:styled-content> &lt;43\u00a0Hz most patients had <jats:styled-content style=\"fixed-case\">CHE<\/jats:styled-content> (85%). Therefore, 27% of patients could avoid further testing with a diagnostic accuracy of 81%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The combination of <jats:styled-content style=\"fixed-case\">MELD<\/jats:styled-content>\u2010score and critical flicker frequency may be used as a first diagnostic step to filter patients, in whom further covert hepatic encephalopathy testing could be avoided.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.13721","type":"journal-article","created":{"date-parts":[[2016,7,7]],"date-time":"2016-07-07T07:52:44Z","timestamp":1467877964000},"page":"514-521","source":"Crossref","is-referenced-by-count":22,"title":["Stepwise diagnosis in covert hepatic encephalopathy: critical flicker frequency and <scp>MELD<\/scp>\u2010score as a first\u2010step approach"],"prefix":"10.1111","volume":"44","author":[{"given":"R.","family":"Greinert","sequence":"first","affiliation":[{"name":"Department of Internal Medicine I 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