Performance characterization of a novel electronic number connection test to detect minimal hepatic encephalopathy in cirrhotic patients

• Published in: European journal of gastroenterology & hepatology Vol. 29; no. 4; pp. 456 - 463
• Main Authors: Wuensch, Tilo, Ruether, Darius Ferenc, Zöllner, Caroline, Mueller, Tobias, Jung, Tobias, Kaffarnik, Magnus, Kassner, Ursula, Schott, Eckart, Kiefer, Stephan, Pratschke, Johann, Stockmann, Martin, Jara, Maximilian
• Format: Journal Article
• Language: English
• Published: England Copyright Wolters Kluwer Health, Inc. All rights reserved 01-04-2017
• Subjects: Adult; Age Factors; Aged; Cognition Disorders - diagnosis; Cognition Disorders - etiology; Computers, Handheld; Educational Status; Feasibility Studies; Female; Hepatic Encephalopathy - diagnosis; Hepatic Encephalopathy - etiology; Hepatic Encephalopathy - psychology; Humans; Liver Cirrhosis - complications; Liver Cirrhosis - psychology; Male; Middle Aged; Neuropsychological Tests; Psychometrics; Reproducibility of Results; Sensitivity and Specificity; Sex Factors; Young Adult
• ISSN: 0954-691X; 1473-5687
• DOI: 10.1097/MEG.0000000000000806

BACKGROUND AND AIMHepatic encephalopathy (HE) is a frequent complication of cirrhosis, characterized by cognitive deficits that negatively impact patients’ quality of life. The mild, minimal hepatic encephalopathy (mHE) can only be detected by psychometric tests and early mHE detection can prevent more severe complications or even survival times. Here, we aimed to investigate the feasibility and validity of the novel-developed electronic number connection test (eNCT), which is designed as a fast and easy-to-perform mHE patient self-test.
METHODSThe eNCT design was inspired by the paper-pencil number connection test version A, showing 25 numbers on the screen (1–25), in a random order. The time required to tap on all digits in the correct order was measured. A total of 238 individuals (112 patients with liver cirrhosis) were enrolled in this study and eNCT times were compared with well-established paper-pencil tests. The Psychometric Hepatic Encephalopathy Score test battery was used to detect mHE and cut-off values for mHE detection by the eNCT were defined.
RESULTSOverall, cirrhotic patients showed significantly slower test completion times compared with control participants. The eNCT performance was inversely correlated with Psychometric Hepatic Encephalopathy Score test performance in cirrhotic patients, independent of the HE status. Thirty cirrhotic patients fulfilled the mHE criteria and receiver operating characteristic curve analysis showed high sensitivity (>82%) and specificity (>85%) for mHE detection. Finally, the eNCT showed excellent test–retest reliability (intraclass correlation coefficient=0.94).
CONCLUSIONThe novel eNCT is a reliable HE self-test to monitor cognitive function and detect cognitive impairment in cirrhotic patients.