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A shortened Stroop test to identify covert hepatic encephalopathy and predict overt hepatic encephalopathy in patients with cirrhosis

  • Original Article―Liver, Pancreas, and Biliary Tract
  • Published:
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Abstract

Background

Covert hepatic encephalopathy (CHE) adversely affects the clinical outcomes of patients with cirrhosis but remains largely undiagnosed and untreated. Although the Stroop test is a useful method for CHE detection, a faster, simpler, and more accurate test is required to diagnose CHE. This prospective study aimed to develop a new shortened Stroop test that can detect CHE and predict overt hepatic encephalopathy (OHE) in Japanese patients with cirrhosis.

Methods

Patients who underwent neuropsychological tests (NPT) and the Stroop test between November 2018 and December 2021 were enrolled and followed until OHE occurrence or March 2022. The discriminative ability of various run combinations in the off and on states to detect CHE was evaluated using the area under the receiver-operating characteristic curve (AUC) and compared with that of the total Stroop test time.

Results

Among the 227 eligible patients, the On1–2Time cutoff value of 44.4 s had a comparable discriminative ability with the total Stroop test time to detect CHE, with an AUC of 0.791, a sensitivity of 0.827, and a specificity of 0.685. During a median follow-up period of 16 months, 37 patients developed OHE. On1–2Time ≥ 44.4 s (hazard ratio [HR], 3.93; 95% confidence interval [CI] 1.36–11.36) and serum albumin levels (HR, 0.28; 95% CI 0.11–0.67) were independently associated with OHE occurrence.

Conclusions

The shortened Stroop test (On1–2Time) is equivalent to the total Stroop test not only for identifying CHE but also for estimating the risk of progression to OHE.

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Acknowledgements

This work was supported by a Grant-in-Aid for Research from the Japan Agency for Medical Research and Development (JP22fk0210113).

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Authors and Affiliations

  1. Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan

    Tatsunori Hanai, Takao Miwa, Toshihide Maeda, Yuki Nakahata, Kenji Imai, Atsushi Suetsugu, Koji Takai & Masahito Shimizu

  2. Center for Nutrition Support and Infection Control, Gifu University Hospital, Gifu, Japan

    Kayoko Nishimura

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  1. Tatsunori Hanai
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Contributions

All the authors contributed to the conception and design of this study. TH, KN, TM, TM, YN, KI, AS, and KT: collected and analyzed the data. The first draft of the manuscript was written by TH, and all the authors commented on the previous versions of the manuscript. All the authors have read and approved the final manuscript.

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Correspondence to Tatsunori Hanai.

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Hanai, T., Nishimura, K., Miwa, T. et al. A shortened Stroop test to identify covert hepatic encephalopathy and predict overt hepatic encephalopathy in patients with cirrhosis. J Gastroenterol 57, 981–989 (2022). https://doi.org/10.1007/s00535-022-01925-0

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  • DOI: https://doi.org/10.1007/s00535-022-01925-0

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