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Diagnosis of Minimal Hepatic Encephalopathy Using Stroop EncephalApp: A Multicenter US-Based, Norm-Based Study.
Am J Gastroenterol. 2016 Jan; 111(1):78-86.AJ

Abstract

OBJECTIVES

Diagnosing minimal hepatic encephalopathy (MHE) is challenging, and point-of-care tests are needed. Stroop EncephalApp has been validated for MHE diagnosis in single-center studies. The objective of the study was to validate EncephalApp for MHE diagnosis in a multicenter study.

METHODS

Outpatient cirrhotics (with/without prior overt hepatic encephalopathy (OHE)) and controls from three sites (Virginia (VA), Ohio (OH), and Arkansas (AR)) underwent EncephalApp and two gold standards, psychometric hepatic encephalopathy score (PHES) and inhibitory control test (ICT). Age-/gender-/education-adjusted values for EncephalApp based on direct norms, and based on ICT and PHES, were defined. Patients were followed, and EncephalApp cutoff points were used to determine OHE prediction. These cutoff points were then used in a separate VA-based validation cohort.

RESULTS

A total of 437 cirrhotics (230 VA, 107 OH, 100 AR, 36% OHE, model for end-stage liver disease (MELD) score 11) and 308 controls (103 VA, 100 OH, 105 AR) were included. Using adjusted variables, MHE was present using EncephalApp based on norms in 51%, EncephalApp based on PHES in 37% (sensitivity 80%), and EncephalApp based on ICT in 54% of patients (sensitivity 70%). There was modest/good agreement between sites on EncephalApp MHE diagnosis using the three methods. OHE developed in 13% of patients, which was predicted by EncephalApp independent of the MELD score. In the validation cohort of 121 VA cirrhotics, EncephalApp directly and based on gold standards remained consistent for MHE diagnosis with >70% sensitivity.

CONCLUSIONS

In this multicenter study, EncephalApp, using adjusted population norms or in the context of existing gold standard tests, had good sensitivity for MHE diagnosis and predictive capability for OHE development.

Authors+Show Affiliations

Internal Medicine and Gastroenterology, Cleveland Clinic, Cleveland, Ohio, USA.University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.Family and Community Health Nursing and Biostatistics, Richmond, Virginia, USA.Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia, USA.Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia, USA.University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.Internal Medicine and Gastroenterology, Cleveland Clinic, Cleveland, Ohio, USA.Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia, USA.Psychiatry, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia, USA.University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.Internal Medicine and Gastroenterology, Cleveland Clinic, Cleveland, Ohio, USA.Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia, USA.Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia, USA.Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia, USA.

Pub Type(s)

Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Validation Study

Language

eng

PubMed ID

26644276

Citation

Allampati, Sanath, et al. "Diagnosis of Minimal Hepatic Encephalopathy Using Stroop EncephalApp: a Multicenter US-Based, Norm-Based Study." The American Journal of Gastroenterology, vol. 111, no. 1, 2016, pp. 78-86.
Allampati S, Duarte-Rojo A, Thacker LR, et al. Diagnosis of Minimal Hepatic Encephalopathy Using Stroop EncephalApp: A Multicenter US-Based, Norm-Based Study. Am J Gastroenterol. 2016;111(1):78-86.
Allampati, S., Duarte-Rojo, A., Thacker, L. R., Patidar, K. R., White, M. B., Klair, J. S., John, B., Heuman, D. M., Wade, J. B., Flud, C., O'Shea, R., Gavis, E. A., Unser, A. B., & Bajaj, J. S. (2016). Diagnosis of Minimal Hepatic Encephalopathy Using Stroop EncephalApp: A Multicenter US-Based, Norm-Based Study. The American Journal of Gastroenterology, 111(1), 78-86. https://doi.org/10.1038/ajg.2015.377
Allampati S, et al. Diagnosis of Minimal Hepatic Encephalopathy Using Stroop EncephalApp: a Multicenter US-Based, Norm-Based Study. Am J Gastroenterol. 2016;111(1):78-86. PubMed PMID: 26644276.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diagnosis of Minimal Hepatic Encephalopathy Using Stroop EncephalApp: A Multicenter US-Based, Norm-Based Study. AU - Allampati,Sanath, AU - Duarte-Rojo,Andres, AU - Thacker,Leroy R, AU - Patidar,Kavish R, AU - White,Melanie B, AU - Klair,Jagpal S, AU - John,Binu, AU - Heuman,Douglas M, AU - Wade,James B, AU - Flud,Christopher, AU - O'Shea,Robert, AU - Gavis,Edith A, AU - Unser,Ariel B, AU - Bajaj,Jasmohan S, Y1 - 2015/12/08/ PY - 2015/07/02/received PY - 2015/10/02/accepted PY - 2015/12/9/entrez PY - 2015/12/9/pubmed PY - 2016/6/9/medline SP - 78 EP - 86 JF - The American journal of gastroenterology JO - Am J Gastroenterol VL - 111 IS - 1 N2 - OBJECTIVES: Diagnosing minimal hepatic encephalopathy (MHE) is challenging, and point-of-care tests are needed. Stroop EncephalApp has been validated for MHE diagnosis in single-center studies. The objective of the study was to validate EncephalApp for MHE diagnosis in a multicenter study. METHODS: Outpatient cirrhotics (with/without prior overt hepatic encephalopathy (OHE)) and controls from three sites (Virginia (VA), Ohio (OH), and Arkansas (AR)) underwent EncephalApp and two gold standards, psychometric hepatic encephalopathy score (PHES) and inhibitory control test (ICT). Age-/gender-/education-adjusted values for EncephalApp based on direct norms, and based on ICT and PHES, were defined. Patients were followed, and EncephalApp cutoff points were used to determine OHE prediction. These cutoff points were then used in a separate VA-based validation cohort. RESULTS: A total of 437 cirrhotics (230 VA, 107 OH, 100 AR, 36% OHE, model for end-stage liver disease (MELD) score 11) and 308 controls (103 VA, 100 OH, 105 AR) were included. Using adjusted variables, MHE was present using EncephalApp based on norms in 51%, EncephalApp based on PHES in 37% (sensitivity 80%), and EncephalApp based on ICT in 54% of patients (sensitivity 70%). There was modest/good agreement between sites on EncephalApp MHE diagnosis using the three methods. OHE developed in 13% of patients, which was predicted by EncephalApp independent of the MELD score. In the validation cohort of 121 VA cirrhotics, EncephalApp directly and based on gold standards remained consistent for MHE diagnosis with >70% sensitivity. CONCLUSIONS: In this multicenter study, EncephalApp, using adjusted population norms or in the context of existing gold standard tests, had good sensitivity for MHE diagnosis and predictive capability for OHE development. SN - 1572-0241 UR - https://www.unboundmedicine.com/medline/citation/26644276/Diagnosis_of_Minimal_Hepatic_Encephalopathy_Using_Stroop_EncephalApp:_A_Multicenter_US_Based_Norm_Based_Study_ L2 - https://Insights.ovid.com/pubmed?pmid=26644276 DB - PRIME DP - Unbound Medicine ER -