Z Gastroenterol 2019; 57(01): e36
DOI: 10.1055/s-0038-1677137
2. Clinical Hepatology, Surgery, LTX
Georg Thieme Verlag KG Stuttgart · New York

Critical flicker frequency improves after alcohol abstinence

J Mueller
1   Department of Medicine and Center for Alcohol Research, Salem Medical Center, University of Heidelberg, Zeppelinstraße 11 – 33, 69121 Heidelberg, Germany
,
O Elshaarawy
1   Department of Medicine and Center for Alcohol Research, Salem Medical Center, University of Heidelberg, Zeppelinstraße 11 – 33, 69121 Heidelberg, Germany
,
S Lan
1   Department of Medicine and Center for Alcohol Research, Salem Medical Center, University of Heidelberg, Zeppelinstraße 11 – 33, 69121 Heidelberg, Germany
,
V Rausch
1   Department of Medicine and Center for Alcohol Research, Salem Medical Center, University of Heidelberg, Zeppelinstraße 11 – 33, 69121 Heidelberg, Germany
,
HK Seitz
1   Department of Medicine and Center for Alcohol Research, Salem Medical Center, University of Heidelberg, Zeppelinstraße 11 – 33, 69121 Heidelberg, Germany
,
S Mueller
1   Department of Medicine and Center for Alcohol Research, Salem Medical Center, University of Heidelberg, Zeppelinstraße 11 – 33, 69121 Heidelberg, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
04 January 2019 (online)

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    Background:

    Critical flicker frequency (CFF) has been established as reliable bedside test to identify patients with minimal hepatic encephalopathy (MHE), the early form of hepatic encephalopathy. In patients with alcoholic liver disease (ALD), however, it remains unclear whether CFF not only depends on liver stiffness (LS) but also the co-presence of alcohol. In addition, we aim to validate the performance of CFF in patients with ALD.

    Aim:

    To study role of alcohol and LS onCFF in heavy drinkers primarily before and after alcohol withdrawal.

    Methods:

    We prospectively recruited 119 heavy drinkers with all stage of ALD primarily presenting for alcohol detoxification. CFF (Hepatonorm Analyzer; R&R Medi-Business Freiburg GmbH, Freiburg, Germany) was measured prior and after alcohol withdrawal (mean withdrawal time 5.3 days) in 70 patients. In all patients, routine lab parameters and LS (Fibroscan, Echosens, Paris) were performed at baseline and after alcohol detoxification.

    Results:

    CCF could be obtained in 92.5% of patients. 62 patients were diagnosed clinically as encephalopathy grade 0 while grades 1 and 2 were 5 and 3 patients, respectively. CFF was able to diagnose 12.8% of patients with MHE who were missed clinically. CFF values decreased with progression of LS (r = –0.323, p < 0.01). Notably, CFF significantly improved after detoxification from 40.2 to 44.7 Hz (P < 0.001), with the most significant improvement in patients with Child-Pugh-score A. This was mirrored with a significant improvement of mean LS decreasing from 10.1 to 7.5 kPa (P = 0.049). CFF and LS improvement was more pronounced in patients with HE grade 1 and 2 after alcohol detoxification (31.9 vs. 38.8 Hz and 35.4 vs. 41.9 Hz, P < 0.0001, respectively). Unexpectedly, MHE and ALD patients who had no HE, also showed significant improvement of CFF after alcohol abstinence (37.8 vs. 40.9 Hz, P = 0.02 and 43.9 vs. 46.6 Hz, P = 0.006, respectively). Noteworthy, the change of CFF was significantly correlated with the decrease of blood alcohol level (r = –0.657, P = 0.014, r = –0.852, P = 0.0309).

    Conclusion:

    CFF performs well in an ALD cohort primarily presenting for alcohol detoxification. About one third showed clinically inapparent MHE. However, CFF is also affected directly by alcohol intake which should be considered when interpreting CFF data in alcoholics.


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