QuickStroop for screening for minimal hepatic encephalopathy in patients with cirrhosis

QuickStroop, a shortened version of the Stroop EncephalApp, has recently been proposed for screening for minimal hepatic encephalopathy (MHE) in patients with cirrhosis in the USA. At present, there are no data on its clinical utility for MHE screening in patients in Europe, and only limited data are available regarding its comparison to the Animal Naming Test (ANT).

In total, 242 patients with cirrhosis without signs of hepatic encephalopathy (HE) ≥ grade 1 and no history of overt HE were included as the development cohort. Another independent cohort comprising 104 patients with cirrhosis from a different center served as a validation set. MHE was defined using the psychometric hepatic encephalopathy score (PHES) (PHES-MHE). All patients were tested with the complete EncephalApp Stroop. A subset was also tested with the ANT. Regression formulas were fitted for patients above and below the age of 60 years, including the first two off-state runs, age, and school education (QuickStroop).

PHES-MHE was detected in 76 (31%) patients. The first two off-state runs of the EncephalApp demonstrated a comparable discriminative ability to the complete Stroop test in distinguishing between patients with and without PHES-MHE. QuickStroop had a better discriminative ability in patients below than above the age of 60 years. The discriminative ability of QuickStroop (total cohort: AUC 0.88) was superior to ANT (AUC 0.70). QuickStroop predicted PHES-MHE with a sensitivity of 74% and a specificity of 89%, and took a median of only 34.5 s to complete. The acceptable discriminative ability of QuickStroop was confirmed in the validation cohort (AUC 0.81).

QuickStroop is a rapid screening tool to identify patients at risk for PHES-MHE, especially in patients below 60 years of age.

QuickStroop, a shortened version of the Stroop EncephalApp, has recently been proposed for screening for MHE in patients with cirrhosis in the USA. In this study, we validated QuickStroop for patients in Germany with cirrhosis and demonstrate a good diagnostic accuracy for detecting MHE, especially in patients below 60 years of age. Additionally, QuickStroop might be superior to the ANT in patients below 60 years of age. The use of QuickStroop in clinical practice could facilitate screening for MHE.