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Minimal hepatic encephalopathy reduces quality of life, increases the risk of road traffic incidents and predicts progression to overt hepatic encephalopathy and death. Current psychometry-based diagnostic methods are effective, but time-consuming and a universal ‘gold standard’ test has yet to be agreed upon. The Critical Flicker Frequency is a proposed language-independent diagnostic tool for Minimal hepatic encephalopathy, but its accuracy has yet to be confirmed. Professor Taylor-Robinson and colleagues from the United Kingdom assessed the diagnostic accuracy of Critical Flicker Frequency for minimal hepatic encephalopathy by performing a systematic review and meta-analysis of all studies, which report on the diagnostic accuracy of this test. The research team performed a literature search to locate all publications reporting on the diagnostic accuracy of CFF for Minimal hepatic encephalopathy. Data were extracted from 2 × 2 tables or calculated from reported accuracy data. The team performed a meta-analysis of the collated data for sensitivity, specificity, diagnostic odds ratio (DOR) and summary receiver operator curve analysis.  | | The diagnostic odds ratio was 10.9 | | Alimentary Pharmacology & Therapeutics |
Prespecified subgroup analysis and meta-regression were also performed. The researchers identified 9 studies with data for 622 patients. The team found that the summary sensitivity was 61%, specificity was 79%, and diagnostic odds ratio was 10.9. The area under the receiver operator curve was 0.84. The heterogeneity of the diagnostic odds ratio was 74%. Professor Taylor-Robinson's team concludes, "Critical Flicker Frequency has a high specificity and moderate sensitivity for diagnosing minimal hepatic encephalopathy." "Given the advantages of language independence and being both simple to perform and interpret, we suggest the use of critical flicker frequency as an adjunct to psychometric testing."
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