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Multicenter Study
. 2023 Sep 1:11:686.
doi: 10.12688/f1000research.121781.2. eCollection 2022.

EncephalApp Stroop Test for covert hepatic encephalopathy screening in Tunisian cirrhotic patients

Lamine Hamzaoui  1 , Moufida Mahmoudi  1 , Ghanem Mohamed  2 , Hanene Elloumi  3 , Asma Laabidi  4 , Jalel Boubaker  4 , Mona Boudabbous  5 , Nabil Tahri  5 , Imen Jemni  6 , Leila Safer  6 , Taieb Jomni  7 , Hedi Douggui  7 , Dorra Trad  8 , Dalila Gargouri  8 , Shema Ayadi  9 , Radhouane Debbeche  9 , Sami Belhouchet  10 , Ridha Marouani  11 , Imed Cheikh  3 , Mohamed Nabil Abdelli  2
Affiliations
Multicenter Study

EncephalApp Stroop Test for covert hepatic encephalopathy screening in Tunisian cirrhotic patients

Lamine Hamzaoui et al. F1000Res. .

Abstract

Background: Covert hepatic encephalopathy (CHE) is underdiagnosed and is difficult to detect. The EncephalApp Stroop test is validated for its screening. The aim of the study was to define Tunisian norms for the test based on healthy controls norms and to estimate the prevalence of CHE in cirrhotic Tunisian patients. Methods: A prospective, multicenter, cross-sectional study was conducted. Ambulatory or hospitalized cirrhotic patients aged 40 years and over were recruited at 11 centers. Healthy subjects aged 40 years and over were recruited at 8 centers. We used a translated Arabic version of the streamlined EncephalApp Stroop test. The task has two components: "Off" and "On" state depending on the discordance or concordance of the stimuli. Results: 142 patients were included. The mean age was 57.26 years [40-86]. 40 (28.17%) of cirrhotic patients who were included were diagnosed as having a minimal hepatic encephalopathy or CHE. Among the ineligible patients, 22 had overt hepatic encephalopathy. If we consider these patients, the overall prevalence rate of CHE was around 24.39% in cirrhotic patients. It was more frequent in women (34.21% vs 25.96%), and in patients whose level of school education is between 6 and 13 years. Its prevalence does not appear to be affected by gender, MELD score, etiology of cirrhosis and age group of patients, as these variables were independent with respective p according to the chi-square test 0.413; 0.736; 0.663 and 0.1. The stroop times (On / Off and On + Off) correlated significantly with each other, are associated significantly and positively with age (respective Pearson coefficients: 0.578; 0.567 and 0.6). The more the age increases, the more the stroop response times increases (p > 10 -3). Conclusions: EncephalApp Stroop test was an efficient screening tool for CHE in Tunisian cirrhotic patients.

Keywords: Cirrhosis; Medical apps; Subclinical hepatic encephalopathy; Tool; West Haven Criteria.

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Conflict of interest statement

Competing interests: Alpha Sigma

Figures

Figure 1.
Figure 1.. Number of included patients per age groups.
Figure 2.
Figure 2.. CHE prevalence in asymptomatic patients according to regions.
Figure 3.
Figure 3.. CHE prevalence in age groups.
See this image and copyright information in PMC

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