External validation of EncephalApp Stroop test to screen minimal hepatic encephalopathy patients with nonalcoholic cirrhosis  

作　　者：Ting-Ting Jiang Xiao-Li Liu Hao Yu Ya-Xuan Sun Jia-Yan Zhou Zhi-Yun Yang Guang Chen 

机构地区：[1]Center of Integrative Medicine,Beijing Ditan Hospital Affiliated to Capital Medical University,Beijing 100015,China [2]T.H.Chan School of Public Health,Harvard University,Boston,MA 02115,United States [3]School of Medicine,Stanford University,Stanford,CA 94305,United States [4]LKS Faculty of Medicine,University of Hong Kong,Hong Kong 999077,China

出　　处：《World Journal of Hepatology》2024年第12期1450-1457,共8页世界肝病学杂志（英文）

基　　金：Supported by National Science Foundation of China,No.82104781;High Level Public Health Technical Personnel Construction Project,No.leaders-02-16;Dengfeng Talent Support Program of Beijing Municipal Administration of Hospitals,No.DFL20191803;Beijing Hospitals Authority Clinical Medicine Development of Special Funding,No.ZYLX202127;Special Fund of Capital Health Research and Development,No.2020-2-2173;Beijing Municipal Administration of Hospitals Incubating Program,No.PZ20241802.

摘　　要：BACKGROUND Neurocognitive impairment,including minimal hepatic encephalopathy(MHE)and overt hepatic encephalopathy,is one of the most common complications of all types of primary liver diseases,such as hepatitis B,biliary cholangitis,and autoi-mmune hepatitis.The EncephalApp Stroop test is a smartphone application-based test that is time-saving for MHE screening.However,neurocognitive impairment is different between alcoholic cirrhosis patients and nonalcoholic cirrhosis pa-tients,so the cutoff value for MHE diagnosis might be inflated.AIM To validate the Stroop test in nonalcoholic cirrhosis patients.METHODS This external validation was performed at the National Center for Infectious Diseases(Beijing).Liver cirrhosis patients aged between 18 and 65 years who voluntarily enrolled in the study and provided signed informed consent were included.The Psychometric Hepatic Encephalopathy Score(PHES)test was used as the standard diagnostic criterion for MHE.The EncephalApp Stroop test was then performed on the iPad,including two sessions of tests(“off”and“on”)to measure patients’ability to differentiate between numbers and letters.We assessed the performance of the EncephalApp Stroop test in terms of the area under the curve(AUC),sensitivity,specificity,positive predictive value,and negative predictive value,with the PHES as the standard criterion.RESULTS A total of 160 nonalcoholic cirrhosis patients were included in this validation study,including 87(54.4%)patients without MHE and 73(45.6%)patients with MHE.Taking the PHES as the gold standard,the EncephalApp Stroop test performed well for nonalcoholic liver cirrhosis patients in terms of“off”time[AUC:0.85,95%confidence interval(CI):0.79-0.91]and“on+off”time(AUC:0.85,95%CI:0.80-0.91);however,total runs of“off”session(AUC:0.61,95%CI:0.52-0.69),total runs of“on”session(AUC:0.57,95%CI:0.48-0.65),and“on–off”time(AUC:0.54,95%CI:0.44-0.63)were comparatively low.The optimal cutoff points were“off”time>101.93 seconds and“on+off”time>205

关 键 词：Minimal hepatic encephalopathy Nonalcoholic cirrhosis EncephalApp Stroop test DIAGNOSIS SCREENING 

分 类 号：R575.3[医药卫生—消化系统]