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EncephalApp accurately diagnosed covert HE among cirrhotic patients

The EncephalApp, a smartphone application, showed good face and external validity and test-retest reliability when measuring for covert hepatic encephalopathy among cirrhotic patients, according to data from a recent study.

Jasmohan S. Bajaj, MD, division of gastroenterology, hepatology and nutrition, Virginia Commonwealth University and McGuire VA Medical Center, and colleagues studied 167 patients with cirrhosis (38% with overt hepatic encephalopathy [OHE]; mean MELD score, 12) and 114 controls to determine the validity and efficacy of diagnosing covert HE (CHE). Researchers compared iPad vs. iPod/iPhone versions of the EncephalApp, a streamlined version of the Stroop App, for testing.

Jasmohan S. Bajaj

Each patient was given the EncephalApp and paper and pencil cognitive tests. Measured EncephalApp results included: OffTime, OnTime, OffTime+OnTime and the number of runs required to complete five off and on runs where patients had to react and touch appropriate colors on the screen. Thirty-six cirrhotic patients underwent driving simulation tests, and 30 completed test-retest reliability. Another group underwent testing before/after TIPS placement and hyponatremia correction to determine external validity.

Control patients outperformed the cirrhotic group on the EncephalApp and paper-pencil tests. Patients with cirrhosis and OHE performed worse than those without OHE. EncephalApp times and age correlated positively (P<.0001). The area under the receiver operator characteristic (AUROC) was 0.88 in diagnosing CHE in patients without OHE; an OffTime+OnTime value greater than 190 seconds was found in all patients with CHE (AUROC= 0.91).

There also was a positive correlation between crashes and OffTime (P=.03), OnTime (P=.009), the number of runs for the Off (P=.03) and On states (P=.05) and OffTime+OnTime (P=.02).

Overall, there was no significant change in standard paper-pencil tests or EncephalApp results among the test-retest group; a correlation between the two OffTime+OnTime results, however, was observed (P<.0001). EncephalApp performance improved after hyponatermia correction and worsened after TIPS placement, which shows good external validity. No significant differences were seen in EncephalApp results between iPad vs. iPod/iPhone use.

“This app encourages point-of-care testing to select patients who are likely to have covert hepatic encephalopathy and importantly excludes those who do not need further evaluation,” Bajaj told Healio.com. “It can be translated into practice by clinic assistants, nurses or other non-MD professionals to add a cost-effective approach for covert HE diagnosis and could potentially increase treatment for this epidemic.”

Disclosure: The researchers report no relevant financial disclosures.