Validation of EncephalApp_Stroop as screening tool for the detection of minimal hepatic encephalopathy in German patients with liver cirrhosis - 28/05/22
, Katharina Hildebrand a, b, Michael Nagel a, b, Maurice Michel a, b, Wolfgang Maximilian Kremer a, b, Max Hilscher a, b, Peter R. Galle a, b, Jörn M. Schattenberg a, Marcus-Alexander Wörns a, b, c, 1, Christian Labenz a, b, ⁎, 1 Highlights |
• | EncephalApp_Stroop (on+off time) discriminates between patients with and without minimal hepatic encephalopathy with an AUC of 0.87. |
• | EncephalApp_Stroop may be useful as an initial screening tool in a stepwise diagnosis algorithm to reduce elaborate testing with PHES. |
• | Results in EncephalApp_Stroop correlate well with PHES, while there is only a modest correlation with critical flicker frequency. |
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.
Le texte complet de cet article est disponible en PDF.Keywords : End-stage liver disease, Complications of cirrhosis, Hepatic encephalopathy, Point-of-care diagnostic, Smartphone-based testing, Psychometric hepatic encephalopathy score
Abbreviations : AUC, CCM, CFF, CHE, CI, DST, HCC, HE, HE1, IQR, MELD, MHE, NASH, NCT-A, NCT-B, NPV, HE, PHES, PPV, PSE, ROC, SDT, sec
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Vol 46 - N° 4
Article 101873- avril 2022 Retour au numéro
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