EncephalApp stroop test versus electronic number connection test-A for screening minimal hepatic encephalopathy in patients with liver cirrhosis: a comparative study

Abstract

Objectives

Minimal hepatic encephalopathy (MHE) is a common neuropsychiatric complication of liver cirrhosis. Both EncephalApp Stroop test (EncephalApp) and electronic number connection test-A (eNCT-A) are novel computerised psychometric tests for MHE screening. We aimed to compare the efficiency, convenience, accessibility, and acceptability of EncephalApp with that of eNCT-A for MHE screening in cirrhotic patients.

Methods

Ninety-five patients with hepatitis B-induced liver cirrhosis were included and respectively tested by the psychometric hepatic encephalopathy score (PHES), EncephalApp, and eNCT-A. Using PHES as the gold standard for MHE diagnosis, the efficiency of EncephalApp and eNCT-A for MHE screening were respectively analysed by the receiver operating characteristic (ROC) curve, and the areas under the ROC curve (AUROC) were compared. The convenience, accessibility, and acceptability of PHES, EncephalApp and eNCT-A were respectively evaluated by the 5-point Likert scale.

Results

Fifty-two (55%) of included cirrhotic patients were diagnosed with MHE. The EncephalApp had a sensitivity of 84.6%, a specificity of 74.4%, and an AUROC of 0.836. Meanwhile, the eNCT-A had a sensitivity of 78.8%, a specificity of 83.7%, and an AUROC of 0.845. No significant difference in AUROC was detected between the EncephalApp and eNCT-A (p = .453). Compared with the EncephalApp, the eNCT-A presented better convenience and higher acceptability in cirrhotic patients undergoing MHE screening (p = .019 and p < .001, respectively).

Conclusions

As with the EncephalApp, the eNCT-A will be a potential home monitoring and point-of-care tool for cirrhotic patients at high risk of MHE.

Keywords:

• Minimal hepatic encephalopathy
• EncephalApp Stroop test
• electronic number connection test-A

Authors’ contributions

Ming Luo and Fang-Rui Hu designed the study, collected the data, and drafted the manuscript. Peng-Da Wang and Li Yao analyzed and interpreted the data. Sheng-Juan Hu and Fei-Hu Bai revised the manuscript for important intellectual content. All authors approved the final version of the manuscript.

Disclosure statement

The authors have no conflicts of interest to declare.

This study protocol conformed to the ethical guidelines of the 2008 Declaration of Helsinki and was approved by the Ethics Committee of People’s Hospital of Ningxia Hui Autonomous Region. Moreover, the grammar and structure of this paper have been edited by professional editors at Editage, a professional English editing service.

Additional information

Funding

This study was supported by the Ningxia Natural Science Foundation [grant number: 2020AAC03329].