QuickStroop Offers Faster, Accurate Scoring of Covert HE

Investigators have found that a shortened version of the EncephalApp for calculating the psychometric hepatic encephalopathy score (PHES) of patients with liver disease to predict covert hepatic encephalopathy (CHE) provides results that are equally accurate to those of the full version, in just 1 minute.

The authors observed, “Psychometric hepatic encephalopathy score (PHES) is the gold standard against which EncephalApp Stroop has been validated.” CHE is associated with poor outcomes for patients with liver diseases such as cirrhosis and hepatitis.

However, the authors noted, it “is often not diagnosed because of the time requirement.” The standard time required for EncephalApp—"5 runs each in ‘Off’ and ‘On’”, the authors state, can take up to 10 minutes. In this study the researchers set out to determine minimum number of EncephalApp runs required to provide comparable accuracy to the standard.

The team recruited both a derivation cohort and a validation cohort of outpatients with cirrhosis who underwent PHES (gold standard) and total EncephalApp. They analyzed data for individual runs vs total EncephalApp time vs 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,” the investigators wrote. “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 regression formula from the derivation cohort, adjusted for age, gender, and education,  showed an accuracy of 84% in diagnosing PHES-CHE in the validation cohort. The time required for CHE diagnosis decreased from 203.7 seconds (67.82) to 36.8 seconds (11.25) in the derivation cohort, and from 178.2 seconds (46.19) to 32.9 seconds (9.94) in the validation cohort.

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

—Rebecca Mashaw

Reference:
Acharya C, Shaw J, Duong N. QuickStroop, a shortened version of EncephalApp, detects covert hepatic encephalopathy with similar accuracy within one minute. Clin Gastroenterol Hepatol. Published online: January 05, 2022. DOI: 10.1016/j.cgh.2021.12.047