Abstract：
In contrast to overt hepatic encephalopathy (OHE), the diagnosis of minimal HE (MHE) is challenging in patients with cirrhosis requiring elaborate, specialized testing. The EncephalApp_Stroop is a smartphone-based application established as screening tool for the diagnosis of MHE but has not yet been validated in a German cohort and country specific cut-offs are currently missing.
93 patients with cirrhosis were enroled into this study. Psychometric hepatic encephalopathy score (PHES) was used to detect MHE, and a subset of the patients was tested with critical flicker frequency (CFF). All patients underwent testing with EncephalApp_Stroop. Cut-off thresholds for EncephalApp_Stroop were calculated according to Youden\'s Index and a separate cut-off was determined with focus on sensitivity.
24 (26%) patients had MHE according to PHES. EncephalApp_Stroop had a strong correlation with PHES (r=-0.76, p<0.001), while there was only a modest correlation with CFF (r=-0.51, <0.001). On time as well as on+off time discriminated best between patients with and without MHE with AUROCS of 0.87 for both measures. According to Youden\'s index, a cut-off of >224.7 s (sec) (on+off time) discriminated best between patients with and without MHE with a sensitivity of 71% and a specificity of 88%. The adjusted cut-off value for on+off time with focus on sensitivity (sensitivity:specificity weighed 2:1) was 185.1 s, yielding an optimized sensitivity of 92% and a negative predictive value of 96%. By using this cut-off as a pre-screening test in a stepwise diagnosis algorithm, elaborate testing with PHES could have been avoided in 49% of all patients.
EncephalApp_Stroop may be useful in a stepwise diagnosis algorithm or even as a stand-alone screening tool to detect MHE in German patients with cirrhosis.
93 patients with cirrhosis were enroled into this study. Psychometric hepatic encephalopathy score (PHES) was used to detect MHE, and a subset of the patients was tested with critical flicker frequency (CFF). All patients underwent testing with EncephalApp_Stroop. Cut-off thresholds for EncephalApp_Stroop were calculated according to Youden\'s Index and a separate cut-off was determined with focus on sensitivity.
24 (26%) patients had MHE according to PHES. EncephalApp_Stroop had a strong correlation with PHES (r=-0.76, p<0.001), while there was only a modest correlation with CFF (r=-0.51, <0.001). On time as well as on+off time discriminated best between patients with and without MHE with AUROCS of 0.87 for both measures. According to Youden\'s index, a cut-off of >224.7 s (sec) (on+off time) discriminated best between patients with and without MHE with a sensitivity of 71% and a specificity of 88%. The adjusted cut-off value for on+off time with focus on sensitivity (sensitivity:specificity weighed 2:1) was 185.1 s, yielding an optimized sensitivity of 92% and a negative predictive value of 96%. By using this cut-off as a pre-screening test in a stepwise diagnosis algorithm, elaborate testing with PHES could have been avoided in 49% of all patients.
EncephalApp_Stroop may be useful in a stepwise diagnosis algorithm or even as a stand-alone screening tool to detect MHE in German patients with cirrhosis.
摘要：
与明显的肝性脑病（OHE）相反，最小HE（MHE）的诊断在肝硬化患者中具有挑战性，专业测试。EnbheadApp_Stroop是一款基于智能手机的应用程序，可作为MHE诊断的筛查工具，但尚未在德国队列中得到验证，目前缺少特定国家/地区的截止日期。
93例肝硬化患者被纳入本研究。采用心理测量肝性脑病评分(PHES)检测MHE,并且对患者的子集进行了临界闪烁频率(CFF)测试。所有患者均接受了EncephalApp_Stroop测试。根据Youden\'s指数计算EncepharApp_Stroop的截止阈值，并以灵敏度为重点确定单独的截止值。
根据PHES，24例（26%）患者有MHE。EnheadApp_Stroop与PHES有很强的相关性(r=-0.76,p<0.001),而与CFF仅有适度的相关性（r=-0.51，<0.001）。两种措施的AUROCS均为0.87的有MHE和无MHE的患者之间的接通时间和断开时间最好区分。根据尤登的索引，>224.7s(sec)(开+关时间)的截断值在有和没有MHE的患者之间的区别最好,敏感性为71%,特异性为88%.以灵敏度为焦点的开关时间的调整截止值为185.1s(灵敏度:特异性重2:1),产生92%的优化灵敏度和96%的阴性预测值。通过将此截止值用作逐步诊断算法中的预筛选测试，在所有患者中，有49％可以避免使用PHES进行复杂的测试。
EncephalApp_Stroop可能在逐步诊断算法中有用，甚至作为独立的筛查工具来检测德国肝硬化患者的MHE。
93例肝硬化患者被纳入本研究。采用心理测量肝性脑病评分(PHES)检测MHE,并且对患者的子集进行了临界闪烁频率(CFF)测试。所有患者均接受了EncephalApp_Stroop测试。根据Youden\'s指数计算EncepharApp_Stroop的截止阈值，并以灵敏度为重点确定单独的截止值。
根据PHES，24例（26%）患者有MHE。EnheadApp_Stroop与PHES有很强的相关性(r=-0.76,p<0.001),而与CFF仅有适度的相关性（r=-0.51，<0.001）。两种措施的AUROCS均为0.87的有MHE和无MHE的患者之间的接通时间和断开时间最好区分。根据尤登的索引，>224.7s(sec)(开+关时间)的截断值在有和没有MHE的患者之间的区别最好,敏感性为71%,特异性为88%.以灵敏度为焦点的开关时间的调整截止值为185.1s(灵敏度:特异性重2:1),产生92%的优化灵敏度和96%的阴性预测值。通过将此截止值用作逐步诊断算法中的预筛选测试，在所有患者中，有49％可以避免使用PHES进行复杂的测试。
EncephalApp_Stroop可能在逐步诊断算法中有用，甚至作为独立的筛查工具来检测德国肝硬化患者的MHE。
