Validation of EncephalApp_Stroop as screening tool for the detection of minimal hepatic encephalopathy in German patients with liver cirrhosis

Kaps, Leonard; Hildebrand, Katharina; Nagel, Michael; Michel, Maurice Stephan; Kremer, Wolfgang Maximilian; Hilscher, Max; Galle, Peter R.; Schattenberg, Jörn M.; Wörns, Marcus‐Alexander; Labenz, Christian

doi:10.1016/j.clinre.2022.101873

Cited by 10 publications

(8 citation statements)

References 19 publications

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“…However, since this cut-off value displayed limited sensitivity (64.4%), our results are only partially in concordance with the previously mentioned study, in which the authors suggested that a total time of >186.63 s was suggestive of MHE, with a sensitivity of 86% [24]. On the other hand, Kaps et al reported that a total time cut-off value of >224.7 s had the best discriminatory ability for MHE diagnosis in the German population; all of these results are similar to our proposed cut-off values [25]. However, in contrast to this cohort study of Serbian patients, studies in the US population have shown rather good sensitivity and high specificity of the test and effectiveness in assessing the risk of progression to overt hepatic encephalopathy [12].…”

Section: Discussionsupporting

confidence: 92%

EncephalApp Stroop Test as a Screening Tool for the Detection of Minimal Hepatic Encephalopathy in Patients with Cirrhosis—Single-Center Experience

Vojnovic,

Pantic,

Jankovic

et al. 2024

Gastroenterology Insights

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Background: Minimal hepatic encephalopathy (MHE) is the mildest form of hepatic encephalopathy. One of the neuropsychological tests that detects MHE is the Stroop test (via EncephalApp). The aim was to evaluate the Stroop test for the screening and diagnosis of MHE. Methods: This prospective case–control study was performed at the Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, and included patients with cirrhosis and MHE and healthy controls. In all patients, the presence of MHE was confirmed using the animal naming test. The Stroop test was performed on each participant, and the results were compared between the two groups. The test has two components, the “OFF” and “ON” states. Results: A total of 111 participants were included. The median OFF time did not differ between the two groups, 106.3 and 91.4, p > 0.05. However, in patients with MHE, the median values of ON time and total time were significantly higher, with 122.3 vs. 105.3 and 228.0 vs. 195.6, respectively, p < 0.05. Statistical significance between patients and controls in examined parameters was detected in younger participants and the group with higher educational levels. Conclusions: The Stroop test displayed limited sensitivity in Serbian patients. Age and education affect time measurements and test performance.

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Section: Discussionsupporting

confidence: 92%

EncephalApp Stroop Test as a Screening Tool for the Detection of Minimal Hepatic Encephalopathy in Patients with Cirrhosis—Single-Center Experience

Vojnovic,

Pantic,

Jankovic

et al. 2024

Gastroenterology Insights

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“… 13 However, previous studies conducted in different populations have found different optimal diagnostic cutoff values of the Stroop test that range from 186.63 to 274.9 s; meanwhile, even though correlations of results with factors such as age were found, the direct modeling using healthy controls is rarely been established and used. 11 , 12 , 13 , 14 , 15 , 17 , 27 Bajaj et al. established the Stroop diagnostic model based on the characteristics of the American population, but it cannot be directly applied to patients in other countries.…”

Section: Discussionmentioning

confidence: 99%

Detection of minimal hepatic encephalopathy in patients with cirrhosis based on the Stroop‐CN model (NCRCID‐CHESS 2106): a prospective multicenter study

Li,

Liu,

Guo

et al. 2024

MedComm

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Minimal hepatic encephalopathy (MHE) has a substantial impact on the clinical outcomes and quality of life (QOL) of patients with cirrhosis. However, timely diagnosis and intervention are challenging due to sophisticated diagnostic methods. In this study, 673 healthy controls and 905 patients with cirrhosis were screened, and 660 healthy controls and 757 patients with cirrhosis, divided into the test (292 patients) and validation (465 patients) cohort, were analyzed after screening. A diagnostic model of the Stroop test (Stroop‐CN) was constructed by multivariate linear regression based on the results of healthy controls. The prevalence of MHE and the comparison results with psychometric hepatic encephalopathy score through the Stroop‐CN model were stable in the test and validation cohorts. Moreover, the prevalence of MHE remained significantly higher in patients with worse disease conditions marked as high Child–Pugh grades and the Model for End‐stage Liver Disease and Sodium (MELD‐Na) scores in the test and validation cohort. The EuroQol 5‐D questionnaire revealed that patients with MHE had a worse QOL than those without MHE both in the test and validation cohort. In conclusion, an easy and practical Stroop‐CN model for MHE diagnosis based on the EncephalApp is established. It is found that a considerable number of Chinese patients with cirrhosis experience MHE, which significantly impacts their QOL.

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“…This might be due to the multiple mental function aspects of CHE which may or may not be impaired simultaneously at the same level, and to the greater or lesser suitability of each test for a particular abnormality of mental function. For example, the PHES is most reliable for measuring cognitive impairment, whereas the Stroop test is good at evaluating attention and concentration capacities, ICT focuses on assessing executive functions such as attention and response inhibition, the CFF test concentrates on visual discrimination, and RBANS is specialized in revealing deficits in verbal and visual anterograde memory, working memory, cognitive processing speed, language ability, and visuospatial ability 21,24–28 . Therefore, in 2022 the European Association for the Study of the Liver (EASL) guidelines stated that there was no gold standard for the diagnosis of CHE and that each test or tool had its advantages and disadvantages 1 .…”

Section: Discussionmentioning

confidence: 99%

Prevalence and risk factors of covert hepatic encephalopathy in cirrhotic patients: A multicenter study in China

Zeng

Yin

Sun

et al. 2023

J of Digest Diseases

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Objective: We aimed to investigate the prevalence of covert hepatic encephalopathy (CHE) in cirrhotic patients in China and its risk factors.Methods: A multicenter prospective observational study was conducted from January 2021 to March 2022 at 16 medical centers across China to investigate the risk factors of CHE and establish a prediction model for CHE episodes.Results: A total of 528 patients were enrolled in the study. Based on both the psychometric hepatic encephalopathy score and Stroop test results, the prevalence of CHE was 50.4% (266/528), and the consistency between these two tests was 68.9%.Multivariate analysis showed that age (odds ratio [OR] 1.043, 95% confidence interval [CI] 1.022-1.063, P < 0.001), duration of education (OR 0.891, 95% CI 0.832-0.954, P = 0.001), comorbidities of cardiovascular diseases, hypertension, cerebral

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Validation of EncephalApp_Stroop as screening tool for the detection of minimal hepatic encephalopathy in German patients with liver cirrhosis

Cited by 10 publications

References 19 publications

EncephalApp Stroop Test as a Screening Tool for the Detection of Minimal Hepatic Encephalopathy in Patients with Cirrhosis—Single-Center Experience

EncephalApp Stroop Test as a Screening Tool for the Detection of Minimal Hepatic Encephalopathy in Patients with Cirrhosis—Single-Center Experience

Detection of minimal hepatic encephalopathy in patients with cirrhosis based on the Stroop‐CN model (NCRCID‐CHESS 2106): a prospective multicenter study

Prevalence and risk factors of covert hepatic encephalopathy in cirrhotic patients: A multicenter study in China

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