External validation of EncephalApp Stroop test to screen minimal hepatic encephalopathy patients with nonalcoholic cirrhosis

Table 1 Description of the characteristics of patients in the validation data set and distinguished by minimal hepatic encephalopathy diagnosis, n (%)

Characteristics	All patients (n = 160)	Without MHE (n = 87)	With MHE (n = 73)
Age, mean ± SD, year1	52.3 ± 11.3	48.7 ± 11.0	56.7 ± 10.1
Sex
Female	52 (32.5)	28 (32.2)	24 (32.9)
Male	108 (67.5)	59 (67.8)	49 (67.1)
Primary liver disease
Hepatitis B	123 (76.8)	71 (81.6)	52 (71.2)
Hepatitis C	14 (8.8)	6 (6.9)	8 (11.0)
Autoimmune hepatitis	11 (6.9)	4 (4.6)	7 (9.6)
Others	12 (7.5)	6 (6.9)	6 (8.2)
Child-Pugh Score1
Grade A	97 (60.6)	63 (72.5)	34 (46.6)
Grade B	51 (31.9)	23 (26.4)	28 (38.4)
Grade C	12 (7.5)	1 (1.2)	11 (15.0)
MELD	11.4 (4.0)	10.9 (3.7)	12.0 (4.3)
ALT, U/L	46.2 (107.7)	49.8 (94.0)	42.0 (122.6)
AST, U/L	55.7 (130.3)	52.8 (75.9)	59.2 (175.0)
ALB, g/L	38.1 (29.5)	40.6 (39.7)	35.1 (5.0)
INR	1.3 (0.2)	1.3 (0.2)	1.4 (0.3)
K, μmol/L	3.9 (0.4)	3.8 (0.3)	3.9 (0.4)
Na, μmol/L	140.4 (3.4)	140.5 (2.9)	140.2 (3.8)
Cr, mL/min	69.4 (21.0)	67.1 (15.3)	72.1 (26.0)
WBC, 109/L	3.8 (1.9)	4.0 (2.1)	3.6 (1.6)
HGB, g/L1	118.5 (25.8)	122.8 (25.8)	113.3 (25.0)
PLT, 109/L	98.1 (82.0)	109.8 (99.2)	84.0 (52.1)

¹Significant differences were observed between minimal hepatic encephalopathy patients and non-minimal hepatic encephalopathy patients.

MHE: Minimal hepatic encephalopathy; MELD: Model for end-stage liver disease; ALT: Alanine transaminase; AST: Aspartate transferase; INR: International normalized ratio; ALB: Albumin; Cr: Creatinine; WBC: White blood cell; HGB: Hemoglobin; PLT: Platelet.

Table 2 Performance of the EncephalApp Stroop test in the diagnosis of minimal hepatic encephalopathy in nonalcoholic liver cirrhotic patients

Parameters	AUC (95%CI)	Optimal cutoff	Sensitivity	Specificity	Precision, PPV	NPV
Off time, second	0.85 (0.79-0.91)	101.93	0.84	0.77	0.75	0.85
On time, second	0.84 (0.78-0.90)	104.51	0.89	0.71	0.73	0.90
On + off time, second	0.85 (0.80-0.91)	205.86	0.90	0.71	0.72	0.89
On - off time, second	0.54 (0.44-0.63)	14.95	0.45	0.71	0.57	0.61
Total runs of off session	0.61 (0.52-0.69)	6.50	0.38	0.83	0.65	0.62
Total runs of on session	0.57 (0.48-0.65)	5.50	0.66	0.48	0.52	0.63

AUC: Area under the curve; CI: Confidence interval; PPV: Positive predictive value; NPV: Negative predictive value.