The efficacy of the EncephalApp in diagnosing minimal hepatic encephalopathy (MHE) among patients with liver cirrhosis in Jos Nigeria

Background and Objectives: Minimal hepatic encephalopathy is a condition in which patients with liver cirrhosis with normal mental and neurological status on clinical examination show cognitive dysfunction detectable on psychometric or neurophysiologic tests. Routine detection of this condition is not commonly carried out despite the high prevalence among patients with liver cirrhosis and a high risk of progression to overt hepatic encephalopathy. We compared the smartphone based EncephalApp with the standard psychometric hepatic encephalopathy score (PHES) in diagnosing MHE in patients with liver cirrhosis in Jos University Teaching Hospital. Materials and Methods: Fifty healthy subjects and 42 patients with liver cirrhosis who did not have overt hepatic encephalopathy and who fulfilled other study criteria were recruited in this cross-sectional analytical study. Both healthy subjects and patients were tested with the EncephalApp, and with the paper-pencil PHES test. Data analysis was done using Statistical Package for the Social Sciences (SPSS) 23.0. A value of P < 0.05 was considered statistically significant. Results: The mean age of the control group was 35.9 ± 8.7 years, whereas that of the patient group was 38.9 ± 8.7, P = 0.099. The mean number of years in school for the control group was 16.5 ± 3.4 years, whereas that of the patients was 16.1 ± 3.1, P = 0.471. The prevalence of MHE by PHES was 40.5%. The prevalence of MHE by EncephalApp was 51.4% based on the cutoff of 241.8 s, sensitivity = 54.1% and specificity = 90.0%, AUROC = 0.77. Conclusion: The prevalence of MHE in patients with liver cirrhosis in Jos, Nigeria, is about the same with values documented in other parts of the world. The EncephalApp was shown to be a reliable screening tool with good sensitivity, specificity and AUROC in our patients with liver cirrhosis.