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      Score Psicométrico para Encefalopatía Hepática y EncephalApp en el diagnóstico de la encefalopatía hepática encubierta en Cuba Translated title: The Psychometric Score for Hepatic Encephalopathy and the Stroop EncephalApp in the diagnosis of covert hepatic encephalopathy in Cuba

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          Abstract

          RESUMEN Introducción: El diagnóstico de la encefalopatía hepática encubierta en pacientes con cirrosis hepática se encuentra en estado de cambio, fundamentalmente en lo que a las pruebas diagnósticas refiere. Objetivo: El objetivo de este estudio fue comparar los resultados diagnósticos de dos test, el Score Psicométrico para Encefalopatía Hepática y el Stroop EncephalApp en el diagnóstico de encefalopatía hepática encubierta. Materiales y métodos: Se aplicaron ambos test en pacientes cirróticos ambulatorios de la consulta de cirrosis hepática en el Hospital “Arnaldo Milián”, provincia de Villa Clara, comparando los resultados del EncephalApp tomando como prueba de referencia el Score Psicométrico para Encefalopatía Hepática. Las variables edad, sexo y escolaridad fueron ajustadas según normas poblacionales. Resultados: Un total de 80 cirróticos, así como 520 controles sanos fueron incluidos. Utilizando el Stroop EncephalApp el 35% de los cirróticos presentaban encefalopatía hepática encubierta, al utilizar el Score Psicométrico para Encefalopatía Hepática la presencia de encefalopatía hepática encubierta fue del 40%, mostrando el Stroop EncephalApp un 80% de sensibilidad y 82% de especificidad. Conclusiones: La encefalopatía hepática encubierta no diagnosticada muestra una elevada incidencia en cirróticos. El Score Psicométrico para Encefalopatía Hepática y el Stroop EncephalApp muestran una adecuada sensibilidad en el diagnóstico de Encefalopatía hepática encubierta.

          Translated abstract

          ABSTRACT Introduction: The early diagnosis of occult hepatic encephalopathy in patients with liver cirrhosis is currently a challenge, mainly with regard to diagnostic tests. Objetive: The aim of this study was to compare the results of two tests, the psychometric score for hepatic encephalopathy and the Stroop EncephalApp in the diagnosis of covert hepatic encephalopathy. Materials and methods: The two tests were applied in patients in the cirrhosis consultation of the "Arnaldo Milián" Hospital in Villa Clara, comparing the results of Stroop EncephalApp taking as reference the psychometric score for hepatic encephalopathy. The variables age, sex and schooling were adjusted according to population norms. Results: A total of 80 cirrhotic patients were included, as well as 520 healthy controls. Using the Stroop EncephalApp, 35% presented covert hepatic encephalopathy, when the Psychometric score for hepatic encephalopathy was used. The prevalence was 40%, showing the sensitivity of Stroop EncephalApp of 80% and 82% of specificity. Conclusions: undiagnosed occult hepatic encephalopathy shows a high prevalence in cirrhosis. The psychometric score for hepatic encephalopathy and Stroop EncephalApp show adequate sensitivity in the diagnosis of occult hepatic encephalopathy.

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          Neuropsychological characterization of hepatic encephalopathy.

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            The Stroop smartphone application is a short and valid method to screen for minimal hepatic encephalopathy.

            Minimal hepatic encephalopathy (MHE) detection is difficult because of the unavailability of short screening tools. Therefore, MHE patients can remain undiagnosed and untreated. The aim of this study was to use a Stroop smartphone application (app) (EncephalApp_Stroop) to screen for MHE. The app and standard psychometric tests (SPTs; 2 of 4 abnormal is MHE, gold standard), psychometric hepatic encephalopathy score (PHES), and inhibitory control tests (ICTs) were administered to patients with cirrhosis (with or without previous overt hepatic encephalopathy; OHE) and age-matched controls from two centers; a subset underwent retesting. A separate validation cohort was also recruited. Stroop has an "off" state with neutral stimuli and an "on" state with incongruent stimuli. Outcomes included time to complete five correct runs as well as number of trials needed in on (Ontime) and off (Offtime) states. Stroop results were compared between controls and patients with cirrhosis with or without OHE and those with or without MHE (using SPTs, ICTs, and PHES). Receiver operating characteristic analysis was performed to diagnose MHE in patients with cirrhosis with or without previous OHE. One hundred and twenty-five patients with cirrhosis (43 previous OHE) and 134 controls were included in the original cohort. App times were correlated with Model for End-Stage Liver Disease (Offtime: r = 0.57; Ontime: r = 0.61; P 274.9 seconds (Ontime plus Offtime) had an area under the curve of 0.89 in all patients and 0.84 in patients without previous OHE for MHE diagnosis using SPT as the gold standard. The validation cohort showed 78% sensitivity and 90% specificity with the >274.9-seconds Ontime plus Offtime cutoff. App result patterns were similar between the centers. Test-retest reliability in controls and those without previous OHE was good; a learning effect on Ontime in patients with cirrhosis without previous OHE was noted. The Stroop smartphone app is a short, valid, and reliable tool for screening of MHE. Copyright © 2013 American Association for the Study of Liver Diseases.
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              Minimal hepatic encephalopathy is associated with motor vehicle crashes: the reality beyond the driving test.

              Patients with minimal hepatic encephalopathy (MHE) have impaired driving skills, but association of MHE with motor vehicle crashes is unclear. Standard psychometric tests (SPT) or inhibitory control test (ICT) can be used to diagnose MHE. The aim was to determine the association of MHE with crashes and traffic violations over the preceding year and on 1-year follow-up. Patients with cirrhosis were diagnosed with MHE by ICT (MHEICT) and SPT (MHESPT). Self and department-of-transportation (DOT)-reports were used to determine crashes and violations over the preceding year. Agreement between self and DOT-reports was analyzed. Patients then underwent 1-year follow-up for crash/violation occurrence. Crashes in those with/without MHEICT and MHESPT were compared. 167 patients with cirrhosis had DOT-reports, of which 120 also had self-reports. A significantly higher proportion of MHEICT patients with cirrhosis experienced crashes in the preceding year compared to those without MHE by self-report (17% vs 0.0%, P = 0.0004) and DOT-reports (17% vs 3%, P = 0.004, relative risk: 5.77). SPT did not differentiate between those with/without crashes. A significantly higher proportion of patients with crashes had MHEICT compared to MHESPT, both self-reported (100% vs 50%, P = 0.03) and DOT-reported (89% vs 44%, P = 0.01). There was excellent agreement between self and DOT-reports for crashes and violations (Kappa 0.90 and 0.80). 109 patients were followed prospectively. MHEICT patients had a significantly higher future crashes/violations compared to those without (22% vs 7%, P = 0.03) but MHESPT did not. MHEICT (Odds ratio: 4.51) and prior year crash/violation (Odds ratio: 2.96) were significantly associated with future crash/violation occurrence. Patients with cirrhosis and MHEICT have a significantly higher crash rate over the preceding year and on prospective follow-up compared to patients without MHE. ICT, but not SPT performance is significantly associated with prior and future crashes and violations. There was an excellent agreement between self- and DOT-reports.
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                Author and article information

                Journal
                rgp
                Revista de Gastroenterología del Perú
                Rev. gastroenterol. Perú
                Sociedad de Gastroenterología del Perú (Lima, , Peru )
                1022-5129
                January 2021
                : 41
                : 1
                : 21-26
                Affiliations
                [1] Santa Clara orgnameHospital Universitario “Dr. Celestino Hernández Robau orgdiv1Departamento de Gastroenterología Cuba
                Article
                S1022-51292021000100021 S1022-5129(21)04100100021
                10.47892/rgp.2021.411.1239
                6cfa855c-53f9-472e-9eee-34f56c52b1f9

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 01 April 2021
                : 28 February 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 27, Pages: 6
                Product

                SciELO Peru

                Categories
                Artículos originales

                Psychometrics,Hepatic encephalopathy: Liver cirrhosis,Psicometria,Cirrosis hepática,Encefalopatía hepática

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