Validation of the simplified Animal Naming Test as primary screening tool for the diagnosis of covert hepatic encephalopathy

Christian Labenz, Larissa Beul, Gerrit Toenges, Jörn M. Schattenberg, Michael Nagel, Martin F. Sprinzl, Marc Nguyen-Tat, Tim Zimmermann, Yvonne Huber, Jens U. Marquardt, Peter R. Galle, Marcus Alexander Wörns*

*Corresponding author for this work
9 Citations (Scopus)


Background: Diagnosis of covert hepatic encephalopathy (CHE) is time consuming in clinical practice. Recently, a new diagnostic tool - the simplified Animal Naming Test (S-ANT1) - was presented with promising results in an Italian cohort. The aim of the present study was to validate S-ANT1 in a cohort of cirrhotic patients from a German tertiary referral centre. Methods: 143 cirrhotic patients and 37 healthy controls were enrolled. Hepatic encephalopathy (HE) grade 1 (HE1) was clinically diagnosed according to the West-Haven Criteria. Critical flicker frequency and Psychometric Hepatic Encephalopathy Score were used to detect minimal HE (MHE). All participants were additionally examined by S-ANT1. Results: 58 (40.6%) patients presented with CHE (40 MHE, 18 HE1). S-ANT1 was lowest in patients with HE1, followed by patients with MHE, patients without CHE, and healthy controls, respectively (each p < 0.05). Naming <20 animals discriminated best between patients with and without CHE in ROC analysis (with Youden's index). With a cut-off value of ≥23 mentioned animal names further testing for CHE could be avoided in 38.5% of patients with a negative predictive value of 84%. Conclusions: S-ANT1 may become an important first screening tool for the assessment of CHE in clinical practice.

Original languageEnglish
JournalEuropean Journal of Internal Medicine
Pages (from-to)96-100
Number of pages5
Publication statusPublished - 02.2019


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