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Utility of the EncephalApp Stroop Test for covert hepatic encephalopathy screening in Chinese cirrhotic patients
Author(s) -
Zeng Xin,
Li XiaoXue,
Shi PeiMei,
Zhang YuanYuan,
Song Yang,
Liu Qing,
Wei Lai,
Bajaj Jasmohan S,
Zhu YanHua,
Li Yi,
Gu Yan,
Xie WeiFen,
Liu YuLan
Publication year - 2019
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.14656
Subject(s) - medicine , hepatic encephalopathy , odds ratio , stroop effect , cutoff , encephalopathy , receiver operating characteristic , diagnostic odds ratio , population , gastroenterology , pediatrics , cirrhosis , psychiatry , cognition , physics , quantum mechanics , environmental health
Abstract Background and Aim Considering the large size of the potential population and limitations of common detection methods, covert hepatic encephalopathy (CHE) is difficult to screen for routinely. The present study aims to explore EncephalApp Stroop Test as a smartphone‐based CHE screening tool in China. Methods A multicenter, single‐visit study was carried out. The cutoff of the Chinese EncephalApp translation was determined by using Chinese standardized psychometric hepatic encephalopathy score (PHES) in cirrhotic patients as the gold standard. Indicators reflecting time required and number of tests on subtask on (naming the color of pound signs) and off (naming the color of the word in discordant coloring) were recorded, with the feedback from investigators and patients. Results One hundred forty‐four patients were included; 58 (40.28%) patients were diagnosed with CHE by PHES. The cutoff of > 97.34 s for off time and > 186.63 s for on time + off time had the maximum area under the curve values (0.77) in all patients. Furthermore, with the cutoff of 186.63 s, on time + off time has the highest sensitivity (0.86). However, the specificity was unsatisfactory (0.59). Age and alcoholic hepatitis (odds ratio = 1.05 and 3.12, both P < 0.05) were positively correlated with the risk of CHE. The experience with electronic devices and education duration were negatively correlated (odds ratio = 0.21 and 0.92, both P < 0.05). Compared with PHES, EncephalApp represented 38% time saving. Furthermore, it was superior to PHES regarding accessibility, convenience, and acceptability by administrators (all P < 0.05). Conclusions The EncephalApp Stroop Test is an efficient screening tool for CHE in Chinese cirrhotic patients.