Minimal Hepatic Encephalopathy Is Associated with Motor Vehicle Crashes

作者：Jasmohan Singh Bajaj, Kia Saeian, Christine M. Schubert, Muhammad Hafeezullah, José Franco, Rajiv R. Varma, Douglas P. Gibson, Raymond G. Hoffmann, Todd R. Stravitz, Douglas M. Heuman, Richard K. Sterling, Mitchell L. Shiffman, Allyne Topaz, Sherry L. Boyett, Debulon E. Bell, Arun Jayant Sanyal · 发表于：Hepatology · 年份：2009 · DOI：10.1002/hep.23128 · 被引用次数：325 · 研究领域：Liver Disease and Transplantation、Liver Disease Diagnosis and Treatment、Older Adults Driving Studies

UNLABELLED: Patients with minimal hepatic encephalopathy (MHE) have impaired driving skills, but association of MHE with motor vehicle crashes is unclear. Standard psychometric tests (SPT) or inhibitory control test (ICT) can be used to diagnose MHE. The aim was to determine the association of MHE with crashes and traffic violations over the preceding year and on 1-year follow-up. Patients with cirrhosis were diagnosed with MHE by ICT (MHEICT) and SPT (MHESPT). Self and department-of-transportation (DOT)-reports were used to determine crashes and violations over the preceding year. Agreement between self and DOT-reports was analyzed. Patients then underwent 1-year follow-up for crash/violation occurrence. Crashes in those with/without MHEICT and MHESPT were compared. 167 patients with cirrhosis had DOT-reports, of which 120 also had self-reports. A significantly higher proportion of MHEICT patients with cirrhosis experienced crashes in the preceding year compared to those without MHE by self-report (17% vs 0.0%, P = 0.0004) and DOT-reports (17% vs 3%, P = 0.004, relative risk: 5.77). SPT did not differentiate between those with/without crashes. A significantly higher proportion of patients with crashes had MHEICT compared to MHESPT, both self-reported (100% vs 50%, P = 0.03) and DOT-reported (89% vs 44%, P = 0.01). There was excellent agreement between self and DOT-reports for crashes and violations (Kappa 0.90 and 0.80). 109 patients were followed prospectively. MHEICT patie...