Animal Naming Test no rastreamento de encefalopatia hepática em pacientes com cirrose

Abstract

[EN] Introduction: Minimal hepatic encephalopathy (MHE) is a subtle yet clinically relevant neuropsychiatric complication of liver cirrhosis, impacting quality of life and increasing the risk of overt hepatic encephalopathy. Early identification of MHE is crucial for appropriate clinical management, but the availability of effective and accessible diagnostic tests remains limited. The Simplified Animal Naming Test at One Minute (S-ANT1) is a rapid and easy-to-administer test that evaluates semantic verbal fluency and may be useful for MHE screening. However, its validation in the Brazilian population has not yet been performed. Objective: To assess the performance of SANT1 in identifying hepatic encephalopathy in patients with liver cirrhosis in the Brazilian population, comparing it with the Psychometric Hepatic Encephalopathy Score (PHES) and the Critical Flicker Frequency (CFF) test. Methods: A crosssectional observational study with prospective inclusion of patients with liver cirrhosis attending the Clementino Fraga Filho University Hospital – UFRJ. Patients underwent assessment using the S-ANT1, PHES, and CFF tests. The S-ANT1 was analyzed in both the age- and education-adjusted version (S-ANT1) and the unadjusted version (ANT1). The concordance between tests and their ability to identify hepatic encephalopathy were evaluated. Results: A total of 114 patients were included, with a mean age of 63±10 years, 57% of whom were female. The predominant etiology of cirrhosis was hepatitis C (39.5%), followed by metabolic dysfunction-associated steatotic liver disease (12.3%). Most patients (80%) had compensated cirrhosis (Child-Pugh A). Hepatic encephalopathy was diagnosed in 34% of patients based on PHES or clinical evaluation. The mean S-ANT1 score was 19±5 animals. A cutoff of 15 animals had a specificity of 92% and a negative predictive value of 73% for diagnosing hepatic encephalopathy, while a cutoff of 20 animals demonstrated higher sensitivity (74%) for detecting MHE. No significant association was found between SANT1 and CFF. When comparing ANT1 with S-ANT1, the unadjusted version performed better in the studied population. Conclusion: The S-ANT1 proved to be a promising tool for identifying MHE in patients with liver cirrhosis in the Brazilian population. Its simplicity and accessibility make it a viable alternative for clinical screening, particularly in resource-limited settings. Further studies are needed to validate its use in different clinical scenarios and broader populations.