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Stroop test, Quickstroop, and the 1-min animal naming test for minimal hepatic encephalopathy diagnosis: A
Juan F Ortiz-Treviño1, Alma L Kuljacha-Gastélum1, Alejandro Tovar-Durán2
1Gastroenterology department, high specialty medical unit (UMAE) No. 25, Northeast National Medical Center, IMSS, Monterrey, Nuevo León, P.C. 64320, Mexic.
Introduction And Objectives:
Although the Psychometric Hepatic Encephalopathy Score (PHES) remains the gold standard in diagnosing minimal hepatic encephalopathy (MHE), its complexity limits its application in clinical practice. While more convenient tests, such as the Stroop test, Quickstroop, and the 1-min animal naming test (ANT-1), have emerged, they haven't been validated in our setting. Our objective was to validate these tests in our population.
Patients And Methods:
This multicenter, observational, descriptive, and cross-sectional study was conducted in three hospitals in northeastern Mexico. MHE was defined as a PHES <-4. We included patients with cirrhosis aged >15 years without a history of overt hepatic encephalopathy. Data regarding sex, age, education, Child-Pugh/MELD-Na scores, etiology of cirrhosis, diabetes, hypertension, obesity, ascites, and clinically significant portal hypertension was collected. Fisher's exact test, Mann-Whitney U test, and receiver operating characteristic (ROC) curves were used for statistical analysis.
Results:
Of the 121 patients included, 35.5 % were diagnosed with MHE. The presence of MHE was significantly associated with education level, years of study, and scores in the Stroop test, Quickstroop, and ANT-1. The AUROC curves were 77.9 %, 74.6 %, and 72.7 % for the Stroop test, Quickstroop, and ANT-1, respectively. The resulting cut-off points were 218.398 (sensitivity: 74 %; specificity: 74 %), 40.535 (sensitivity: 77 %; specificity: 68 %), and <16 animals (sensitivity: 58 %; specificity: 79 %), respectively.
Conclusions:
These tests are valid diagnostic tools for detecting MHE in our population. Their simpler use and applicability could increase the early diagnosis of MHE and prompt primary prophylaxis initiation for overt hepatic encephalopathy.
Insights
Simpler tests like the Stroop, Quickstroop, and animal naming test (ANT-1) effectively diagnose minimal hepatic encephalopathy (MHE) in Mexican patients, offering a practical alternative to the standard PHES score.
Area of Science:
- Hepatology
- Neurology
- Diagnostic Medicine
Background:
- The Psychometric Hepatic Encephalopathy Score (PHES) is the standard for diagnosing minimal hepatic encephalopathy (MHE) but is complex for clinical use.
- Convenient alternatives like the Stroop test, Quickstroop, and 1-min animal naming test (ANT-1) lack validation in many settings.
Purpose of the Study:
- To validate the diagnostic utility of the Stroop test, Quickstroop, and ANT-1 for minimal hepatic encephalopathy (MHE) in a Mexican population.
- To compare the performance of these simpler tests against the established PHES criteria.
Main Methods:
- A multicenter, observational, cross-sectional study in northeastern Mexico included 121 patients with cirrhosis.
- Minimal hepatic encephalopathy (MHE) was defined using the PHES score (<-4).
- Statistical analysis involved Fisher's exact test, Mann-Whitney U test, and receiver operating characteristic (ROC) curves.
Main Results:
- 35.5% of patients were diagnosed with MHE, with significant associations found with education and scores on the Stroop, Quickstroop, and ANT-1 tests.
- Area under the ROC curves (AUROC) were 77.9% for Stroop, 74.6% for Quickstroop, and 72.7% for ANT-1.
- Optimal cut-off points were determined for each test, demonstrating varying sensitivity and specificity.
Conclusions:
- The Stroop test, Quickstroop, and ANT-1 are validated and reliable diagnostic tools for minimal hepatic encephalopathy (MHE) in this population.
- The simpler application of these tests can facilitate earlier MHE diagnosis and timely initiation of prophylaxis for overt hepatic encephalopathy.
