Modified-orientation log to assess hepatic encephalopathy
Article first published online: 21 FEB 2012
© 2012 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 35, Issue 8, pages 913–920, April 2012
How to Cite
Salam, M., Matherly, S., Farooq, I. S., Stravitz, R. T., Sterling, R. K., Sanyal, A. J., Gibson, D. P., Wade, J. B., Thacker, L. R., Heuman, D. M., Fuchs, M., Puri, P., Luketic, V., Bickston, S. J. and Bajaj, J. S. (2012), Modified-orientation log to assess hepatic encephalopathy. Alimentary Pharmacology & Therapeutics, 35: 913–920. doi: 10.1111/j.1365-2036.2012.05038.x
- Issue published online: 21 MAR 2012
- Article first published online: 21 FEB 2012
- Manuscript Accepted: 30 JAN 2012
- Manuscript Revised: 22 JAN 2012
- Manuscript Revised: 19 DEC 2011
- Manuscript Received: 21 NOV 2011
- American College of Gastroenterology Junior Faculty Development Award
- NIH NIDDK. Grant Number: R01DK087913
- NIAAA. Grant Number: R01AA020203
- NCRR. Grant Number: UL1RR031990
The subjectivity of the West-Haven criteria (WHC) hinders hepatic encephalopathy (HE) evaluation. The new HE classification has emphasised assessment of orientation. The modified-orientation log (MO-log, eight questions, scores 0–24; 24 normal) is adapted from a validated brain injury measure.
To validate MO-log for HE assessment in cirrhosis.
Cirrhotics admitted with/without HE were administered MO-log. We collected cirrhosis/HE details, admission/daily MO-logs and WHC (performed by different examiners), time to reach normal mentation (MO-log ≥23) and MO-log/WHC change (Δ) over day 1. Outcomes were in-hospital mortality, duration to normal mentation and length-of-stay (LOS). Regressions were performed for each outcome. MO-log inter-rater reliability was measured.
Ninety-six HE (55 ± 8 years, MELD 21) and 20 non-HE (54 ± 5 years, MELD 19) in-patients were included. In HE patients, median admission WHC was 3 (range 1–4). Mean MO-log was 12 ± 8 (range 0–22). Their LOS was 6 ± 5 days and 13% died. Time to reach normal mentation was 2.4 ± 1.7 days. Concurrent validity: there was a significant negative correlation between admission MO-log and WHC (r = −0.79, P < 0.0001). Discriminant validity: admission MO-logs were significantly lower in those who died (7 vs. 12, P = 0.03) and higher in those admitted without HE (23.6 vs. 12, P < 0.0001). MO-log improved in 69% on day 1 (ΔMO-log 4 ± 8) which was associated with lower duration to normal mentation (2 vs. 3.5 days, P = 0.03) and mortality (3% vs.43%, P < 0.0001), not ΔWHC. Regression models for all outcomes included admission/ΔMO-log but not WHC as a predictor. Inter-rater reliability: ICC for MO-log inter-rater observations was 0.991.
Modified-orientation log is a valid tool for assessing severity and is better than West-Haven criteria in predicting outcomes in hospitalised hepatic encephalopathy patients.