Utility of the EncephalApp Stroop Test for covert hepatic encephalopathy screening in Chinese cirrhotic patients

J Gastroenterol Hepatol. 2019 Oct;34(10):1843-1850. doi: 10.1111/jgh.14656. Epub 2019 Apr 7.


Background and aim: Considering the large size of the potential population and limitations of common detection methods, covert hepatic encephalopathy (CHE) is difficult to screen for routinely. The present study aims to explore EncephalApp Stroop Test as a smartphone-based CHE screening tool in China.

Methods: A multicenter, single-visit study was carried out. The cutoff of the Chinese EncephalApp translation was determined by using Chinese standardized psychometric hepatic encephalopathy score (PHES) in cirrhotic patients as the gold standard. Indicators reflecting time required and number of tests on subtask on (naming the color of pound signs) and off (naming the color of the word in discordant coloring) were recorded, with the feedback from investigators and patients.

Results: One hundred forty-four patients were included; 58 (40.28%) patients were diagnosed with CHE by PHES. The cutoff of > 97.34 s for off time and > 186.63 s for on time + off time had the maximum area under the curve values (0.77) in all patients. Furthermore, with the cutoff of 186.63 s, on time + off time has the highest sensitivity (0.86). However, the specificity was unsatisfactory (0.59). Age and alcoholic hepatitis (odds ratio = 1.05 and 3.12, both P < 0.05) were positively correlated with the risk of CHE. The experience with electronic devices and education duration were negatively correlated (odds ratio = 0.21 and 0.92, both P < 0.05). Compared with PHES, EncephalApp represented 38% time saving. Furthermore, it was superior to PHES regarding accessibility, convenience, and acceptability by administrators (all P < 0.05).

Conclusions: The EncephalApp Stroop Test is an efficient screening tool for CHE in Chinese cirrhotic patients.

Keywords: EncephalApp Stroop Test; cirrhosis; covert hepatic encephalopathy; screening.

Publication types

  • Multicenter Study
  • Validation Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • China
  • Female
  • Hepatic Encephalopathy / diagnosis*
  • Hepatic Encephalopathy / etiology
  • Hepatic Encephalopathy / psychology
  • Humans
  • Liver Cirrhosis / complications*
  • Liver Cirrhosis / diagnosis
  • Male
  • Middle Aged
  • Mobile Applications*
  • Predictive Value of Tests
  • Psychometrics
  • Reproducibility of Results
  • Smartphone*
  • Stroop Test*
  • Young Adult