ENCEPHALAPP STROOP TO DETECT COVERT HEPATIC ENCEPHALOPATHY IN PATIENTS WITH COMPENSATED CIRRHOSIS

Introduction and Objectives

Covert hepatic encephalopathy (CHE) is a common complication in patients with compensated cirrhosis, associated with subtle cognitive impairment and a worse prognosis. The EncephalApp Stroop is a digital tool that facilitates its identification.

To evaluate the diagnostic capacity of the EncephalApp Stroop to identify CHE in patients with compensated cirrhosis

Materials and Methods

A diagnostic evaluation study was conducted in patients with compensated cirrhosis treated at the Institute of Gastroenterology in Havana, Cuba, between March 2023 and December 2024. All participants completed the EncephalApp Stroop and the Psychometric Hepatic Encephalopathy Score (PHES). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined. The discriminatory capacity of the test was assessed using ROC curve analysis, considering a cutoff point of >190 seconds in the “on” time metric plus “off” time, and the PHES result as the gold standard.

Results

Seventy patients of both sexes were included, with a predominance of viral etiology (74.3%). The prevalence of EHE was 38.6%. The EncephalApp Stroop showed a sensitivity of 95.2% (95% CI: 77.3% to 99.2%) and specificity of 85.7% (95% CI: 73.3% to 92.9%), PPV of 74.1% (95% CI: 55.3% to 86.8%) and NPV of 97.7% (95% CI: 87.9% to 99.6%) for the detection of HSE, with an area under the ROC curve of 0.905 (95% CI: 0.826-0.984).

Conclusions

The EncephalApp Stroop is a valid, accessible, and efficient diagnostic test for identifying EHE in compensated cirrhosis, with high performance compared to PHES as the gold standard. Its implementation can optimize early detection and clinical management.