Jiang et al explored the diagnostic capabilities of EncephalApp,a smartphone-based Stroop Test,in patients with nonalcoholic liver disease.The study included 160 patients with nonalcoholic cirrhosis and utilized the p...Jiang et al explored the diagnostic capabilities of EncephalApp,a smartphone-based Stroop Test,in patients with nonalcoholic liver disease.The study included 160 patients with nonalcoholic cirrhosis and utilized the psychometric hepatic encephalopathy score as a benchmark for diagnosing minimal encephalopathy.The identified optimal cutoff times were>101.93 seconds for the"off"time and>205.86 seconds for the combined"on+off"time,demonstrating sensitivities of 0.84 and 0.90,and specificities of 0.77 and 0.71,respectively.The findings suggest the necessity of employing different cutoffs for patients with alcoholic vs no-nalcoholic liver cirrhosis,reflecting the distinct pathophysiologies underlying each condition.Additionally,alcohol consumption itself may influence Stroop test outcomes.Therefore,it is reasonable to establish separate benchmarks for alcoholic and nonalcoholic cirrhotic patients.Further validation in larger patient cohorts with clinical outcomes is essential.The demand for noninvasive liver disease assessments remains high in clinical practice.展开更多
BACKGROUND Neurocognitive impairment,including minimal hepatic encephalopathy(MHE)and overt hepatic encephalopathy,is one of the most common complications of all types of primary liver diseases,such as hepatitis B,bil...BACKGROUND Neurocognitive impairment,including minimal hepatic encephalopathy(MHE)and overt hepatic encephalopathy,is one of the most common complications of all types of primary liver diseases,such as hepatitis B,biliary cholangitis,and autoi-mmune hepatitis.The EncephalApp Stroop test is a smartphone application-based test that is time-saving for MHE screening.However,neurocognitive impairment is different between alcoholic cirrhosis patients and nonalcoholic cirrhosis pa-tients,so the cutoff value for MHE diagnosis might be inflated.AIM To validate the Stroop test in nonalcoholic cirrhosis patients.METHODS This external validation was performed at the National Center for Infectious Diseases(Beijing).Liver cirrhosis patients aged between 18 and 65 years who voluntarily enrolled in the study and provided signed informed consent were included.The Psychometric Hepatic Encephalopathy Score(PHES)test was used as the standard diagnostic criterion for MHE.The EncephalApp Stroop test was then performed on the iPad,including two sessions of tests(“off”and“on”)to measure patients’ability to differentiate between numbers and letters.We assessed the performance of the EncephalApp Stroop test in terms of the area under the curve(AUC),sensitivity,specificity,positive predictive value,and negative predictive value,with the PHES as the standard criterion.RESULTS A total of 160 nonalcoholic cirrhosis patients were included in this validation study,including 87(54.4%)patients without MHE and 73(45.6%)patients with MHE.Taking the PHES as the gold standard,the EncephalApp Stroop test performed well for nonalcoholic liver cirrhosis patients in terms of“off”time[AUC:0.85,95%confidence interval(CI):0.79-0.91]and“on+off”time(AUC:0.85,95%CI:0.80-0.91);however,total runs of“off”session(AUC:0.61,95%CI:0.52-0.69),total runs of“on”session(AUC:0.57,95%CI:0.48-0.65),and“on–off”time(AUC:0.54,95%CI:0.44-0.63)were comparatively low.The optimal cutoff points were“off”time>101.93 seconds and“on+off”time>205.86 seconds,with sensitivities of 0.84 and 0.90,specificities of 0.77 and 0.71,positive predictive values of 0.75 and 0.72,and false-positive values of 0.85 and 0.89,respectively.CONCLUSION Our results suggest that different cutoffs should be used for the EncephalApp Stroop tool for MHE screening between alcoholic and nonalcoholic living patients,which is a critical check before generalization to screen for neurocognitive impairment among the whole population of chronic liver diseases.展开更多
文摘Jiang et al explored the diagnostic capabilities of EncephalApp,a smartphone-based Stroop Test,in patients with nonalcoholic liver disease.The study included 160 patients with nonalcoholic cirrhosis and utilized the psychometric hepatic encephalopathy score as a benchmark for diagnosing minimal encephalopathy.The identified optimal cutoff times were>101.93 seconds for the"off"time and>205.86 seconds for the combined"on+off"time,demonstrating sensitivities of 0.84 and 0.90,and specificities of 0.77 and 0.71,respectively.The findings suggest the necessity of employing different cutoffs for patients with alcoholic vs no-nalcoholic liver cirrhosis,reflecting the distinct pathophysiologies underlying each condition.Additionally,alcohol consumption itself may influence Stroop test outcomes.Therefore,it is reasonable to establish separate benchmarks for alcoholic and nonalcoholic cirrhotic patients.Further validation in larger patient cohorts with clinical outcomes is essential.The demand for noninvasive liver disease assessments remains high in clinical practice.
基金Supported by National Science Foundation of China,No.82104781High Level Public Health Technical Personnel Construction Project,No.leaders-02-16+3 种基金Dengfeng Talent Support Program of Beijing Municipal Administration of Hospitals,No.DFL20191803Beijing Hospitals Authority Clinical Medicine Development of Special Funding,No.ZYLX202127Special Fund of Capital Health Research and Development,No.2020-2-2173Beijing Municipal Administration of Hospitals Incubating Program,No.PZ20241802.
文摘BACKGROUND Neurocognitive impairment,including minimal hepatic encephalopathy(MHE)and overt hepatic encephalopathy,is one of the most common complications of all types of primary liver diseases,such as hepatitis B,biliary cholangitis,and autoi-mmune hepatitis.The EncephalApp Stroop test is a smartphone application-based test that is time-saving for MHE screening.However,neurocognitive impairment is different between alcoholic cirrhosis patients and nonalcoholic cirrhosis pa-tients,so the cutoff value for MHE diagnosis might be inflated.AIM To validate the Stroop test in nonalcoholic cirrhosis patients.METHODS This external validation was performed at the National Center for Infectious Diseases(Beijing).Liver cirrhosis patients aged between 18 and 65 years who voluntarily enrolled in the study and provided signed informed consent were included.The Psychometric Hepatic Encephalopathy Score(PHES)test was used as the standard diagnostic criterion for MHE.The EncephalApp Stroop test was then performed on the iPad,including two sessions of tests(“off”and“on”)to measure patients’ability to differentiate between numbers and letters.We assessed the performance of the EncephalApp Stroop test in terms of the area under the curve(AUC),sensitivity,specificity,positive predictive value,and negative predictive value,with the PHES as the standard criterion.RESULTS A total of 160 nonalcoholic cirrhosis patients were included in this validation study,including 87(54.4%)patients without MHE and 73(45.6%)patients with MHE.Taking the PHES as the gold standard,the EncephalApp Stroop test performed well for nonalcoholic liver cirrhosis patients in terms of“off”time[AUC:0.85,95%confidence interval(CI):0.79-0.91]and“on+off”time(AUC:0.85,95%CI:0.80-0.91);however,total runs of“off”session(AUC:0.61,95%CI:0.52-0.69),total runs of“on”session(AUC:0.57,95%CI:0.48-0.65),and“on–off”time(AUC:0.54,95%CI:0.44-0.63)were comparatively low.The optimal cutoff points were“off”time>101.93 seconds and“on+off”time>205.86 seconds,with sensitivities of 0.84 and 0.90,specificities of 0.77 and 0.71,positive predictive values of 0.75 and 0.72,and false-positive values of 0.85 and 0.89,respectively.CONCLUSION Our results suggest that different cutoffs should be used for the EncephalApp Stroop tool for MHE screening between alcoholic and nonalcoholic living patients,which is a critical check before generalization to screen for neurocognitive impairment among the whole population of chronic liver diseases.
