Wuensch Tilo, Ruether Darius Ferenc, Zöllner Caroline, Mueller Tobias, Jung Tobias, Kaffarnik Magnus, Kassner Ursula, Schott Eckart, Kiefer Stephan, Pratschke Johann, Stockmann Martin, Jara Maximilian
Departments of aSurgery bGastroenterology and Hepatology cCenter for Musculoskeletal Surgery dOutpatient Clinic for Lipid Metabolism Disorders, Interdisciplinary Metabolism Center, Charite Campus Virchow-Klinikum, Charité - Universitatsmedizin Berlin, Berlin eFraunhofer Institute for Biomedical Engineering (IBMT), St Ingbert, Germany.
Eur J Gastroenterol Hepatol. 2017 Apr;29(4):456-463. doi: 10.1097/MEG.0000000000000806.
Hepatic encephalopathy (HE) is a frequent complication of cirrhosis, characterized by cognitive deficits that negatively impact patients' quality of life. The mild, minimal hepatic encephalopathy (mHE) can only be detected by psychometric tests and early mHE detection can prevent more severe complications or even survival times. Here, we aimed to investigate the feasibility and validity of the novel-developed electronic number connection test (eNCT), which is designed as a fast and easy-to-perform mHE patient self-test.
The eNCT design was inspired by the paper-pencil number connection test version A, showing 25 numbers on the screen (1-25), in a random order. The time required to tap on all digits in the correct order was measured. A total of 238 individuals (112 patients with liver cirrhosis) were enrolled in this study and eNCT times were compared with well-established paper-pencil tests. The Psychometric Hepatic Encephalopathy Score test battery was used to detect mHE and cut-off values for mHE detection by the eNCT were defined.
Overall, cirrhotic patients showed significantly slower test completion times compared with control participants. The eNCT performance was inversely correlated with Psychometric Hepatic Encephalopathy Score test performance in cirrhotic patients, independent of the HE status. Thirty cirrhotic patients fulfilled the mHE criteria and receiver operating characteristic curve analysis showed high sensitivity (>82%) and specificity (>85%) for mHE detection. Finally, the eNCT showed excellent test-retest reliability (intraclass correlation coefficient=0.94).
The novel eNCT is a reliable HE self-test to monitor cognitive function and detect cognitive impairment in cirrhotic patients.
肝性脑病（HE）是肝硬化常见的并发症，其特征为认知缺陷，对患者生活质量产生负面影响。轻度、轻微肝性脑病（mHE）只能通过心理测量测试检测到，早期检测mHE可预防更严重的并发症甚至延长生存时间。在此，我们旨在研究新开发的电子数字连接测试（eNCT）的可行性和有效性，该测试被设计为一种快速且易于执行的mHE患者自我测试。
eNCT的设计灵感来自于纸笔数字连接测试版本A，屏幕上以随机顺序显示25个数字（1 - 25）。测量按正确顺序点击所有数字所需的时间。本研究共纳入238名个体（112例肝硬化患者），并将eNCT测试时间与成熟的纸笔测试进行比较。使用心理测量肝性脑病评分测试组来检测mHE，并确定eNCT检测mHE的临界值。
总体而言，与对照参与者相比，肝硬化患者的测试完成时间明显更慢。在肝硬化患者中，eNCT表现与心理测量肝性脑病评分测试表现呈负相关，与HE状态无关。30例肝硬化患者符合mHE标准，受试者工作特征曲线分析显示，eNCT检测mHE具有高敏感性（>82%）和特异性（>85%）。最后，eNCT显示出出色的重测信度（组内相关系数 = 0.94）。
新型eNCT是一种可靠的HE自我测试，可用于监测肝硬化患者的认知功能并检测认知障碍。
