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A Proof‐of‐Concept Study of Language‐Stratified Assessment for Minimal Hepatic Encephalopathy: Integrating the Animal Naming Test and Serum IL‐6

Hsin-Che Lin Cheng-Jen Chen Tsung-Han Wu P. Gu Chun-Yi Tsai Wey-Ran Lin Chao-Wei Hsu Chun-Yen Lin Rong-Nan Chien Chien‐Hao Huang P. Amodio
Aug 2026 · Kaohsiung Journal of Medical Sciences · 0 citations · 10 references
Medicine

TL;DR

It is suggested that primary spoken language may be associated with ANT1 performance in MHE assessments and Integrating ANT1 with serum IL-6 showed numerically improved discrimination in Mandarin speakers, whereas exploratory demographic calibration of S-ANT1 showed a numerically higher AUROC in Taiwanese Hokkien speakers.

Abstract

ABSTRACT Minimal hepatic encephalopathy (MHE) involves subtle cognitive dysfunction and systemic inflammation and is associated with an increased risk of overt hepatic encephalopathy. The Animal Naming Test (ANT1) is a rapid semantic fluency tool for MHE assessment, but its performance across different primary spoken languages remains unclear. We conducted a prospective proof‐of‐concept study to evaluate the diagnostic performance of ANT1 and serum interleukin‐6 (IL‐6) in Mandarin‐ and Taiwanese Hokkien‐speaking cirrhotic patients. A total of 65 cirrhotic patients and 34 healthy controls were enrolled. Patients completed ANT1, simplified ANT1 (S‐ANT1), and standard psychometric assessments. MHE was defined by abnormal PHES and/or visually assessed EEG slowing. Diagnostic discrimination was evaluated using AUROC analyses stratified by primary spoken language. A post hoc exploratory Taiwanese‐calibrated S‐ANT1 was also assessed in Taiwanese Hokkien‐speaking patients. Sixteen cirrhotic patients (24.6%) were diagnosed with MHE. Patients with MHE had lower ANT1 scores and higher serum IL‐6 levels than those without MHE. In Mandarin‐speaking patients (n = 44), ANT1 demonstrated an AUROC of 0.760, while serum IL‐6 showed an AUROC of 0.841. The composite model combining ANT1 and serum IL‐6 showed a numerically higher AUROC of 0.895, but this improvement was not statistically significant in pairwise DeLong comparisons. In Taiwanese Hokkien‐speaking patients (n = 21), standard ANT1 showed a lower AUROC of 0.679. The exploratory Taiwanese‐calibrated S‐ANT1 showed a numerically higher AUROC of 0.776; however, this post hoc finding was based on a small subgroup with 7 MHE events and requires external validation. This study suggests that primary spoken language may be associated with ANT1 performance in MHE assessments. Integrating ANT1 with serum IL‐6 showed numerically improved discrimination in Mandarin speakers, whereas exploratory demographic calibration of S‐ANT1 showed a numerically higher AUROC in Taiwanese Hokkien speakers. These findings are exploratory and hypothesis‐generating, necessitating validation in larger independent cohorts before clinical implementation.

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