Xin Zeng1, Li-Yuan Zhang2, Qing Liu3, Cui-Hua Lu4, Jue Wei5, Zhi-Wen Shi2, Wei-Rong Huang4, Li-Hong Qu6, Fei Xu7, Xiao-Hang Wang8, Pei-Mei Shi2, Yu Tan2, Wei Tan2, Zong-Li Yuan2, Chun-Yan Xia9, Yu-Lan Liu10, Wei-Fen Xie11. 1. Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China; Department of Gastroenterology, Changzheng Hospital, Second Military Medical University, Shanghai, China. 2. Department of Gastroenterology, Changzheng Hospital, Second Military Medical University, Shanghai, China. 3. Department of Gastroenterology, Peking University People's Hospital, Beijing, China. 4. Department of Gastroenterology, Affiliated Hospital of Nantong University, Nantong University, Nantong, China. 5. Department of Gastroenterology, Tong Ren hospital, Jiaotong University, Shanghai, China. 6. Department of Infectious Disease, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China. 7. Department of Gastroenterology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China. 8. Department of Endoscopy, Changzheng Hospital, Second Military Medical University, Shanghai, China. 9. Department of Pathology, Changzheng Hospital, Second Military Medical University, Shanghai, China. 10. Department of Gastroenterology, Peking University People's Hospital, Beijing, China. Electronic address: liuyulan@pkuph.edu.cn. 11. Department of Gastroenterology, Changzheng Hospital, Second Military Medical University, Shanghai, China. Electronic address: weifenxie@medmail.com.cn.
Abstract
BACKGROUND & AIMS: The EncephalApp Stroop test is a high-sensitivity but low-specificity test that has been used to identify patients with covert hepatic encephalopathy (CHE). We aimed to develop a new strategy to detect CHE, combining EncephalApp Stroop test score with scores from subtests of the psychometric hepatic encephalopathy scoring system (PHES). METHODS: We performed a survey of 569 adult volunteers (229 men) in 9 communities in Shanghai, China, administering the EncephalApp Stroop test to determine the range of scores in the general population. Data from the standard PHES, including the number connection test-A, number connection test-B (NCT-B), line tracing test, serial dotting test (SDT), and digit symbol test, were used as the reference standard for diagnosis of CHE. A combination of the EncephalApp Stroop with subtests of the PHES was used to establish a new strategy for CHE diagnosis. We validated our findings using data from 160 patients with cirrhosis from 5 centers China. RESULTS: We determined the range of EncephalApp Stroop test scores for the volunteers of different decades of age, education levels, and sexes. Age, education level, and sex were independently associated with EncephalApp Stroop test scores. A combination of scores from the EncephalApp Stroop test, the NCT-B, and the SDT identified patients with CHE with the highest level of accuracy, when the standard PHES was used as the reference standard. A combination of scores of 187 sec for the EncephalApp Stroop test and below -1 for the NCT-B or below -1 for the SDT identified patients with CHE with an area under the curve (AUC) of 0.86, 81.0% sensitivity, and 91.9% specificity, and 87.5% accuracy. In the validation cohort, these cutoff scores identified patients with CHE with an AUC of 0.88, 97.1% sensitivity, 79.3% specificity, and 86.9% accuracy. The average time to calculate this score was 374±140 sec, compared 424±115 sec for the entire PHES. CONCLUSION: Scores from the EncephalApp Stroop test, NCT-B, and SDT identify patients with CHE with approximately 87% accuracy, and in a much shorter time than the standard PHES. This score combination could be a valid and convenient method for identifying patients with CHE. chictr.org.cn number, ChiCTR-EDC-17012007, ChiCTR1800019954.
BACKGROUND & AIMS: The EncephalApp Stroop test is a high-sensitivity but low-specificity test that has been used to identify patients with covert hepatic encephalopathy (CHE). We aimed to develop a new strategy to detect CHE, combining EncephalApp Stroop test score with scores from subtests of the psychometric hepatic encephalopathy scoring system (PHES). METHODS: We performed a survey of 569 adult volunteers (229 men) in 9 communities in Shanghai, China, administering the EncephalApp Stroop test to determine the range of scores in the general population. Data from the standard PHES, including the number connection test-A, number connection test-B (NCT-B), line tracing test, serial dotting test (SDT), and digit symbol test, were used as the reference standard for diagnosis of CHE. A combination of the EncephalApp Stroop with subtests of the PHES was used to establish a new strategy for CHE diagnosis. We validated our findings using data from 160 patients with cirrhosis from 5 centers China. RESULTS: We determined the range of EncephalApp Stroop test scores for the volunteers of different decades of age, education levels, and sexes. Age, education level, and sex were independently associated with EncephalApp Stroop test scores. A combination of scores from the EncephalApp Stroop test, the NCT-B, and the SDT identified patients with CHE with the highest level of accuracy, when the standard PHES was used as the reference standard. A combination of scores of 187 sec for the EncephalApp Stroop test and below -1 for the NCT-B or below -1 for the SDT identified patients with CHE with an area under the curve (AUC) of 0.86, 81.0% sensitivity, and 91.9% specificity, and 87.5% accuracy. In the validation cohort, these cutoff scores identified patients with CHE with an AUC of 0.88, 97.1% sensitivity, 79.3% specificity, and 86.9% accuracy. The average time to calculate this score was 374±140 sec, compared 424±115 sec for the entire PHES. CONCLUSION: Scores from the EncephalApp Stroop test, NCT-B, and SDT identify patients with CHE with approximately 87% accuracy, and in a much shorter time than the standard PHES. This score combination could be a valid and convenient method for identifying patients with CHE. chictr.org.cn number, ChiCTR-EDC-17012007, ChiCTR1800019954.
Authors: Chathur Acharya; Jawaid Shaw; Nikki Duong; Andrew Fagan; Sara McGeorge; James B Wade; Leroy R Thacker; Jasmohan S Bajaj Journal: Clin Gastroenterol Hepatol Date: 2022-01-06 Impact factor: 13.576