Cunha-Silva Marlone, Neto Fernando L Ponte, de Araújo Priscila S, Pazinato Lucas V, Greca Raquel D, Secundo Tirzah M L, Imbrizi Marcello R, Monici Leonardo T, Sevá-Pereira Tiago, Mazo Daniel F
Division of Gastroenterology (Gastrocentro), University of Campinas (Unicamp), Campinas, Brazil.
Division of Gastroenterology (Gastrocentro), University of Campinas (Unicamp), Campinas, Brazil.
Ann Hepatol. 2022 Jan-Feb;27(1):100543. doi: 10.1016/j.aohep.2021.100543. Epub 2021 Sep 24.
The EncephalApp Stroop Test was developed to more easily diagnose minimal hepatic encephalopathy (MHE). A cut-off of >274.9sec (ONtime+OFFtime) reached a 78% sensitivity and 90% specificity in the validation study, but it has been poorly studied in Brazil. We aim to analyze the usefulness of this diagnostic method and to describe a cut-off value to screen MHE in Brazil.
In this cross-sectional and single-center study, three positive psychometric tests defined the diagnosis of MHE as the gold standard. We evaluated gender, age, education, familiarity with smartphones, etiology of cirrhosis, Child-Pugh/MELD scores, and previous hepatic encephalopathy (HE). Healthy controls and patients without HE were compared for the task validation. The Chi-square and Mann-Whitney tests, logistic regression analysis, and ROC curves were used for statistical evaluation.
We included 132 patients with cirrhosis (61% male) and 42 controls (62% male) around 51y. Sixty-three were diagnosed with MHE on psychometric tests and 23 had clinical HE. Viral hepatitis (38%) was the major etiology of cirrhosis. The median MELD was 10 and Child-Pugh A was more frequent (70%). There was no significant difference in test results between controls and patients without HE. There was also no influence of gender, age, education, and familiarity with smartphones in the test results. Child-Pugh A was associated with MHE (p=0.0106). A cut-off of >269.8sec (ONtime+OFFtime) had an 87% sensitivity and 77% specificity to detect MHE (p=0.002).
This is a valid and reliable tool for screening MHE. However, optimal cut-off values need to be validated locally.
开发EncephalApp斯特鲁普测试是为了更轻松地诊断轻微肝性脑病（MHE）。在验证研究中，>274.9秒（开启时间+关闭时间）的临界值达到了78%的灵敏度和90%的特异性，但在巴西对其研究较少。我们旨在分析这种诊断方法的实用性，并描述巴西用于筛查MHE的临界值。
在这项横断面单中心研究中，三项阳性心理测量测试将MHE的诊断定义为金标准。我们评估了性别、年龄、教育程度、对智能手机的熟悉程度、肝硬化病因、Child-Pugh/MELD评分以及既往肝性脑病（HE）情况。将健康对照者和无HE的患者进行任务验证比较。采用卡方检验、曼-惠特尼检验、逻辑回归分析和ROC曲线进行统计评估。
我们纳入了约51岁左右的132例肝硬化患者（61%为男性）和42例对照者（62%为男性）。63例经心理测量测试诊断为MHE，23例有临床HE。病毒性肝炎（38%）是肝硬化的主要病因。MELD中位数为10，Child-Pugh A级更为常见（70%）。对照者和无HE的患者之间测试结果无显著差异。性别﹑年龄、教育程度和对智能手机的熟悉程度对测试结果也无影响。Child-Pugh A级与MHE相关（p=0.0106）。>269.8秒（开启时间+关闭时间） 的临界值检测MHE的灵敏度为87%，特异性为77%（p=0.002）。
这是一种筛查MHE的有效且可靠的工具。然而，最佳临界值需要在当地进行验证。
