EncephalApp Stroop Test validation for the screening of minimal hepatic encephalopathy in Brazil
EncephalApp Stroop Test validation for the screening of minimal hepatic encephalopathy in Brazil
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DOI：
10.1016/j.aohep.2021.100543
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发表时间：
2021-10-03
影响因子：
3.8
通讯作者：
Mazo, Daniel F.
中科院分区：
文献类型：
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作者：
Cunha-Silva, Marlone;Ponte Neto, Fernando L.;Mazo, Daniel F.
前言和目的：为了更容易地诊断轻度肝性脑病(MHE)，开发了EncephalApp Stroop测试。在验证研究中，以>；274.9秒(OnTime+Offtime)为临界值达到了78%的灵敏度和90%的特异度，但在巴西研究得很少。我们的目的是分析这种诊断方法的有用性，并描述在巴西筛查MHE的临界值。方法：在这项横断面的单中心研究中，三项积极的心理测验将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、肝硬变的病因、Child-Pugh/MELD评分和既往肝性脑病(HE)。对健康对照组和非肝性脑病患者进行任务验证比较。统计评价采用卡方检验、Mann-Whitney检验、Logistic回归分析和ROC曲线。结果：我们纳入了132名肝硬变患者(61%为男性)和42名对照组(62%为男性)。有63人在心理测验中被诊断为MHE，23人有临床HE。病毒性肝炎(38%)是肝硬变的主要病因。MELD的中位数为10，且ChildPugh A更常见(70%)。对照组与非HE组的检测结果差异无统计学意义。测试结果中也没有性别、年龄、教育程度和对智能手机的熟悉程度的影响。ChildPugh A级与多发性肝病相关(p=0.0106)。以>；269.8s(OnTime+OffTime)为界值，检测MHE的敏感性和特异性分别为87%和77%(p=0.002)。结论：这是一种有效、可靠的MHE筛查工具。然而，最佳截止值需要在当地进行验证。(C)2021年由Elsevier Espana，S.L.U代表南卡罗来纳州Fundacion Clinica Medica Sur，A.C.出版。这是CC BY-NC-ND许可证(http://creativecommons.org/licenses/by-nc-nd/4.0/)下的一篇开放获取文章
Introduction and objectives: 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. Methods: 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. Results: We included 132 patients with cirrhosis (61% male) and 42 controls (62% male) around 51y. Sixtythree 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). Conclusion: This is a valid and reliable tool for screening MHE. However, optimal cut-off values need to be validated locally. (c) 2021 Published by Elsevier Espana, S.L.U. on behalf of Fundacion Clinica Medica Sur, A.C. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)