Innovative diagnostic tool aids screening for minimal hepatic encephalopathy in non-alcoholic cirrhosis patients

Abstract

In this editorial we comment on the article by Jiang et al. We focus on the EncephalApp Stroop test which is an innovative, smartphone-based tool specifically designed for screening minimal hepatic encephalopathy (MHE) in cirrhosis patients. Traditional MHE screening methods, while highly sensitive and specific, are often complex, time-consuming, and require controlled environmental conditions, limiting their widespread clinical use. The EncephalApp Stroop test simplifies the screening process, enhances diagnostic efficiency, and is applicable across diverse cultural contexts. However, the combination of additional biomarkers could further improve diagnostic accuracy. Despite its promising potential, more multicenter clinical studies are required to validate its effectiveness and applicability on a global scale.

Key Words: EncephalApp Stroop test; Minimal hepatic encephalopathy; Cirrhosis; biomarkers; Diagnostic

Core Tip: Compared with the standard criteria of the psychometric hepatic encephalopathy score, which generally has diagnostic value, the EncephalApp Stroop test is an innovative tool. The EncephalApp Stroop test simplifies the screening process, enhances diagnostic efficiency, and is applicable across diverse cultural contexts. The test also takes only a few minutes, largely reducing the workload of clinicians.

INTRODUCTION

In recent years, minimal hepatic encephalopathy (MHE), an early complication in patients with cirrhosis, has gained increasing attention. Although MHE patients exhibit no obvious clinical symptoms, cognitive function is already impaired, and the condition may progress to overt hepatic encephalopathy in severe cases. Early detection of MHE is therefore crucial for timely intervention and prevention of disease progression. Traditional screening methods are cumbersome and time-consuming, limiting their broader application in clinical settings. In recent years, the EncephalApp Stroop test, a mobile application, has become a research focus for screening MHE in cirrhosis patients due to its convenience and high diagnostic accuracy. A recent study[1] on the application of the EncephalApp Stroop test in non-alcoholic cirrhosis patients for MHE screening has drawn considerable attention. This paper explores the clinical value of the EncephalApp Stroop test, the importance of early MHE screening, and potential challenges in its clinical implementation.

CLINICAL PROSPECTS OF THE ENCEPHALAPP STROOP TEST

The EncephalApp Stroop test, a smartphone-based application, offers an innovative solution for screening MHE in cirrhosis patients. Jiang et al[1] have shown that the test evaluates patients' response times in "off" and "on + off" conditions, displaying high sensitivity and specificity (area under the curve = 0.85), effectively simplifying the MHE screening process. Traditional MHE screening methods[2-4], such as psychological scales and neuropsychological tests, although highly sensitive and specific, are complex, time-consuming, and require specific environmental conditions, limiting their broad application, especially in primary healthcare settings. The EncephalApp Stroop test provides a solution to these challenges. Compared to traditional neuropsychological tests, the EncephalApp Stroop test has significant advantages in terms of ease of use and time efficiency, especially for resource-limited healthcare settings. For instance, studies conducted in Brazil[5] and Tunisia[6] have shown positive results following use of the EncephalApp Stroop test for MHE screening across different cultural contexts. These studies validate the tool's applicability across different populations, laying the groundwork for its clinical application. However, despite promising preliminary data, further multicenter, large-scale clinical validation is needed for global promotion of the EncephalApp Stroop test.

CLINICAL SIGNIFICANCE OF EARLY MHE SCREENING AND OPTIMIZED STRATEGIES

Early MHE screening is particularly important in clinical practice. Although MHE may not present with obvious symptoms in its early stages, it significantly impacts patients' quality of life, cognitive function, and long-term prognosis. Studies[7-9] show that MHE patients often exhibit mild deficits in cognitive function, attention, and memory, which can directly affect daily activities and quality of life. Without timely diagnosis, MHE may progress to overt hepatic encephalopathy, leading to higher hospitalization rates, mortality, and healthcare costs, especially in the later stages of cirrhosis. Recent research indicates that MHE is closely linked to prognosis in cirrhosis patients, and early detection and intervention can significantly improve patients' quality of life and clinical outcomes[10]. The EncephalApp Stroop test, through a simple smartphone application, allows patients to complete screening in a short time, providing reliable diagnostic data for clinicians. This innovative screening method not only improves diagnostic efficiency but also enhances accessibility, particularly in resource-limited healthcare settings, where it can quickly identify potential MHE patients and enable timely intervention. This helps more patients to be diagnosed and treated early, reducing the risk of disease progression.

Despite the innovation of the EncephalApp Stroop test, there is still a need to combine additional biomarkers (such as amino acid levels or inflammatory markers) to further improve diagnostic accuracy[11]. Early MHE screening should also be integrated into the routine diagnosis and treatment of cirrhosis patients, especially those without obvious symptoms. Early screening can help develop more precise intervention measures, improving patients' long-term survival rates and quality of life. By optimizing these early screening tools and strategies, MHE prognosis management will be more effective, especially in regions with limited medical resources, helping more patients avoid serious complications.

CHALLENGES AND FUTURE OUTLOOK FOR BROADER APPLICATION

Although the EncephalApp Stroop test has shown significant value in MHE screening, several challenges remain in its widespread application. First, existing studies have small sample sizes, and many are single-center studies, lacking global multicenter data support. Cultural and regional differences may also affect patients' performance in cognitive tests. Therefore, future research should expand sample sizes and conduct multicenter trials to verify the test's generalizability. In addition, effectively integrating the tool into routine clinical workflows and improving patient compliance through education are important challenges to address. The cost-effectiveness of the EncephalApp Stroop test also needs further evaluation to ensure its feasibility for widespread adoption. Future studies should focus on assessing the tool's adaptability across different ethnic and cultural backgrounds and determining promotion strategies through cost-benefit analyses. Through these efforts, the EncephalApp Stroop test is expected to become a standardized global tool for MHE screening.

CONCLUSION

The EncephalApp Stroop test provides an innovative and convenient solution for screening MHE in non-alcoholic cirrhosis patients. It excels in improving diagnostic efficiency and accessibility, particularly in primary healthcare settings. However, further clinical validation studies and adaptability assessments across different cultural backgrounds are required to ensure its broad application for screening cirrhosis patients globally. Through additional research and clinical applications, we anticipate that the EncephalApp Stroop test will bring significant benefits in terms of early diagnosis and intervention in cirrhosis patients.