Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany; Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.
Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany; Cirrhosis Centre Mainz (CCM), University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany.
Clin Res Hepatol Gastroenterol. 2022 Apr;46(4):101873. doi: 10.1016/j.clinre.2022.101873. Epub 2022 Feb 3.
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.
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.
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.
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.
与显性肝性脑病（OHE）相比，在需要精细、专门检测的肝硬化患者中，最小型肝性脑病（MHE）的诊断具有挑战性。EncephalApp_Stroop 是一种基于智能手机的应用程序，已被确立为 MHE 的诊断筛查工具，但尚未在德国队列中得到验证，目前也缺乏特定国家的截断值。
本研究纳入了 93 例肝硬化患者。使用心理测量性肝性脑病评分（PHES）来检测 MHE，其中一部分患者接受临界闪烁频率（CFF）检测。所有患者均接受 EncephalApp_Stroop 测试。根据 Youden 指数计算 EncephalApp_Stroop 的截断值，并确定了一个侧重于敏感性的单独截断值。
根据 PHES，24 例（26%）患者患有 MHE。EncephalApp_Stroop 与 PHES 具有很强的相关性（r=-0.76，p<0.001），而与 CFF 只有适度的相关性（r=-0.51，p<0.001）。时间和+关闭时间在区分有无 MHE 的患者方面表现最佳，AUROCS 分别为 0.87。根据 Youden 指数，截断值>224.7 s（秒）（开+关时间）最佳地区分有无 MHE 的患者，敏感性为 71%，特异性为 88%。在敏感性方面，开+关时间的调整截断值（敏感性：特异性权衡 2：1）为 185.1 s，可优化敏感性为 92%，阴性预测值为 96%。通过在逐步诊断算法中使用此截断值作为预筛选测试，可以避免 49%的所有患者进行 PHES 等精细测试。
EncephalApp_Stroop 可用于逐步诊断算法，甚至可用作德国肝硬化患者 MHE 的独立筛查工具。
