Diagnosis of Minimal Hepatic Encephalopathy Using Stroop EncephalApp: A Multicenter US-Based, Norm-Based Study

Area of Science:

• Hepatology
• Neurology
• Point-of-care diagnostics

Background:

• Diagnosing minimal hepatic encephalopathy (MHE) is challenging, necessitating reliable point-of-care tests.
• The Stroop EncephalApp has shown promise in single-center studies for MHE diagnosis.

Purpose of the Study:

• To validate the EncephalApp for diagnosing MHE in a multicenter setting.
• To assess the EncephalApp's predictive capability for overt hepatic encephalopathy (OHE).

Main Methods:

• A multicenter study involving outpatients with cirrhosis and controls from three sites.
• EncephalApp performance was compared against gold standards: psychometric hepatic encephalopathy score (PHES) and inhibitory control test (ICT).
• Age-, gender-, and education-adjusted EncephalApp values were determined, and cutoff points were used for OHE prediction and validation.

Main Results:

• 437 cirrhotics and 308 controls were included. MHE was diagnosed by EncephalApp (adjusted norms) in 51%, by PHES in 37% (80% sensitivity), and by ICT in 54% (70% sensitivity).
• Modest to good agreement was observed between sites for EncephalApp MHE diagnosis.
• EncephalApp predicted OHE development (13% incidence) independently of MELD score, with >70% sensitivity in a validation cohort.

Conclusions:

• The EncephalApp, utilizing adjusted norms or alongside gold standard tests, exhibits good sensitivity for MHE diagnosis.
• The EncephalApp is a valuable tool for MHE diagnosis and predicting OHE development in cirrhotic patients.