QuickStroop, a Shortened Version of EncephalApp, Detects Covert Hepatic Encephalopathy With Similar Accuracy Within One Minute,Clinical Gastroenterology and Hepatology

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QuickStroop, a Shortened Version of EncephalApp, Detects Covert Hepatic Encephalopathy With Similar Accuracy Within One Minute
Clinical Gastroenterology and Hepatology ( IF 11.6 ) Pub Date : 2022-01-06 , DOI: 10.1016/j.cgh.2021.12.047
Chathur Acharya ₁ , Jawaid Shaw ₁ , Nikki Duong ₁ , Andrew Fagan ₁ , Sara McGeorge ₁ , James B Wade ₂ , Leroy R Thacker ₃ , Jasmohan S Bajaj ₁

Affiliation

Background & Aims

Covert hepatic encephalopathy (CHE) is associated with poor outcomes but is often not diagnosed because of the time requirement. Psychometric hepatic encephalopathy score (PHES) is the gold standard against which EncephalApp Stroop has been validated. However, EncephalApp (5 runs each in “Off” and “On” state) can take up to 10 minutes. This study sought to define the smallest number of EncephalApp runs needed for comparable accuracy to the total EncephalApp using CHE on PHES as gold standard.

Methods

A derivation and a validation cohort of outpatients with cirrhosis who underwent PHES (gold standard) and total EncephalApp was recruited. Data were analyzed for individual runs versus total EncephalApp time versus PHES-CHE. The derivation cohort (n = 398) was split into training (n = 299) and test (n = 99) sets. From the training data set a regression model was created with age, gender, education, and various sums of the “Off” settings. After this, a K-fold cross-validation on the test dataset was performed for both total EncephalApp time and individual Off runs and for the validation cohort.

Results

In both cohorts, Off runs 1 + 2 had statistically similar area under the receiver operating curve and P value to the total EncephalApp for PHES-CHE prediction. The adjusted (age, gender, education) regression formula from the derivation cohort showed an accuracy of 84% to diagnose PHES-CHE in the validation cohort. Time for CHE diagnosis decreased from 203.7 (67.82) to 36.8 (11.25) seconds in the derivation and from 178.2 (46.19) to 32.9 (9.94) seconds in the validation cohort.

Conclusions

QuickStroop, which is completed within 1 minute, gives an equivalent ability to predict CHE on the gold standard compared with the entire EncephalApp time.

中文翻译：

QuickStroop 是 EncephalApp 的简化版本，在一分钟内以相似的准确度检测隐性肝性脑病

背景与目标

隐性肝性脑病 (CHE) 与不良预后相关，但由于时间要求往往未被诊断出来。心理测量肝性脑病评分 (PHES) 是 EncephalApp Stroop 验证的黄金标准。但是，EncephalApp（在“关闭”和“打开”状态下各运行 5 次）最多可能需要 10 分钟。本研究试图定义与使用 PHES 上的 CHE 作为黄金标准的总 EncephalApp 相当的准确性所需的 EncephalApp 运行的最小数量。

方法

招募了接受 PHES（金标准）和 Total EncephalApp 的肝硬化门诊患者的推导和验证队列。分析了单次运行与总 EncephalApp 时间与 PHES-CHE 的数据。推导队列 (n = 398) 分为训练集 (n = 299) 和测试集 (n = 99)。根据训练数据集，使用年龄、性别、教育程度以及“关闭”设置的各种总和创建回归模型。此后，针对总 EncephalApp 时间和单独的 Off 运行以及验证队列，对测试数据集进行了 K 倍交叉验证。

结果

在两个队列中，Off 运行 1 + 2 的接受者操作曲线下面积和P值与用于 PHES-CHE 预测的总 EncephalApp 具有统计相似的面积。推导队列调整后的（年龄、性别、教育程度）回归公式显示，验证队列中诊断 PHES-CHE 的准确度为 84%。推导中的 CHE 诊断时间从 203.7 (67.82) 秒减少到 36.8 (11.25) 秒，验证队列中的 CHE 诊断时间从 178.2 (46.19) 秒减少到 32.9 (9.94) 秒。