Validation of EncephalApp_Stroop as screening tool for the detection of minimal hepatic encephalopathy in German patients with liver cirrhosis.

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  • Additional Information
    • Source:
      Publisher: Elsevier Masson Country of Publication: France NLM ID: 101553659 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2210-741X (Electronic) Linking ISSN: 22107401 NLM ISO Abbreviation: Clin Res Hepatol Gastroenterol Subsets: MEDLINE
    • Publication Information:
      Original Publication: Paris : Elsevier Masson
    • Subject Terms:
      Hepatic Encephalopathy*/diagnosis ; Hepatic Encephalopathy*/etiology; Humans ; Liver Cirrhosis/complications ; Mass Screening ; Predictive Value of Tests ; Psychometrics
    • Abstract:
      Background: In contrast to overt hepatic encephalopathy (OHE), the diagnosis of minimal HE (MHE) is challenging in patients with cirrhosis requiring elaborate, specialized testing. The EncephalApp_Stroop is a smartphone-based application established as screening tool for the diagnosis of MHE but has not yet been validated in a German cohort and country specific cut-offs are currently missing.
      Methods: 93 patients with cirrhosis were enroled into this study. Psychometric hepatic encephalopathy score (PHES) was used to detect MHE, and a subset of the patients was tested with critical flicker frequency (CFF). All patients underwent testing with EncephalApp_Stroop. Cut-off thresholds for EncephalApp_Stroop were calculated according to Youden's Index and a separate cut-off was determined with focus on sensitivity.
      Results: 24 (26%) patients had MHE according to PHES. EncephalApp_Stroop had a strong correlation with PHES (r=-0.76, p<0.001), while there was only a modest correlation with CFF (r=-0.51, <0.001). On time as well as on+off time discriminated best between patients with and without MHE with AUROCS of 0.87 for both measures. According to Youden's index, a cut-off of >224.7 s (sec) (on+off time) discriminated best between patients with and without MHE with a sensitivity of 71% and a specificity of 88%. The adjusted cut-off value for on+off time with focus on sensitivity (sensitivity:specificity weighed 2:1) was 185.1 s, yielding an optimized sensitivity of 92% and a negative predictive value of 96%. By using this cut-off as a pre-screening test in a stepwise diagnosis algorithm, elaborate testing with PHES could have been avoided in 49% of all patients.
      Conclusion: EncephalApp_Stroop may be useful in a stepwise diagnosis algorithm or even as a stand-alone screening tool to detect MHE in German patients with cirrhosis.
      Competing Interests: Declaration of Competing Interest The authors disclose no potential financial or non-financial conflicts of interest.
      (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)
    • Contributed Indexing:
      Keywords: Complications of cirrhosis; End-stage liver disease; Hepatic encephalopathy; Point-of-care diagnostic; Psychometric hepatic encephalopathy score; Smartphone-based testing
    • Publication Date:
      Date Created: 20220206 Date Completed: 20220602 Latest Revision: 20220615
    • Publication Date:
      20240829
    • Accession Number:
      10.1016/j.clinre.2022.101873
    • Accession Number:
      35124289