Detection of minimal hepatic encephalopathy in patients with cirrhosis based on the Stroop-CN model (NCRCID-CHESS 2106): a prospective multicenter study

Xiaoyan Li; Shanghao Liu; Ying Guo; Hongmei Zu; Huiling Xiang; Shaoqi Yang; Xiaoning Zhang; Fanping Meng; Yangzhen Bianba; Jie Li; Fei Liu; Chuang Lei; Jiaojian Lv; Qiao-hua Yang; Wei Fu; Wei Ye; Jiafang Chen; Yanjing Gao; Caiyun Wu; Ningning Wang; Qi Zheng; Fang Wang; Jiali Yu; Jing Wang; Xiaoting Yang; Xiangmei Wang; Yayuan Liu; Xuelan Zhao; Chenxi Wu; Wei Gou; Jasmohan S. Bajaj; Fu-Sheng Wang; Junliang Fu; Xiaolong Qi

doi:10.1002/mco2.627

MedComm ›› 2024, Vol. 5 ›› Issue (8) : e627 DOI: 10.1002/mco2.627

ORIGINAL ARTICLE

Detection of minimal hepatic encephalopathy in patients with cirrhosis based on the Stroop-CN model (NCRCID-CHESS 2106): a prospective multicenter study

Xiaoyan Li ¹^,²
, Shanghao Liu ³^,⁴^,⁵
, Ying Guo ⁶
, Hongmei Zu ⁷
, Huiling Xiang ⁸
, Shaoqi Yang ⁹
, Xiaoning Zhang ²
, Fanping Meng ²
, Yangzhen Bianba ¹⁰
, Jie Li ¹¹
, Fei Liu ¹²
, Chuang Lei ¹³
, Jiaojian Lv ¹⁴
, Qiao-hua Yang ¹⁵
, Wei Fu ¹⁶
, Wei Ye ¹⁷
, Jiafang Chen ¹⁸
, Yanjing Gao ¹⁹
, Caiyun Wu ²⁰
, Ningning Wang ²¹
, Qi Zheng ²²
, Fang Wang ²³
, Jiali Yu ²⁴
, Jing Wang ²⁵
, Xiaoting Yang ²⁶
, Xiangmei Wang ²⁷
, Yayuan Liu ²⁸
, Xuelan Zhao ²⁹
, Chenxi Wu ³⁰
, Wei Gou ³¹
, Jasmohan S. Bajaj ³²^,^†
, Fu-Sheng Wang ¹^,²^,^†
, Junliang Fu ¹^,²^,^†
, Xiaolong Qi ³^,⁴^,⁵^,^†

Author information +

¹. Medical School of Chinese PLA, Beijing, China

². Senior Department of Infectious Diseases, The Fifth Medical Center of Chinese PLA General Hospital, National Clinical Research Center for Infectious Diseases, Beijing, China

³. Center of Portal Hypertension, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology (Southeast University), Nanjing, China

⁴. Basic Medicine Research and Innovation Center of Ministry of Education, Zhongda Hospital, Southeast University, Nanjing, China

⁵. State Key Laboratory of Digital Medical Engineering, Nanjing, China

⁶. Department of Hepatology, The Third People’s Hospital of Taiyuan, Taiyuan, China

⁷. Department of Gastroenterology, The Fourth People’s Hospital of Qinghai Province, Xining, China

⁸. Department of Gastroenterology and Hepatology, Tianjin Third Central Hospital, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Institute of Hepatobiliary Disease, Tianjin, China

⁹. Department of Gastroenterology, The General Hospital of Ningxia Medical University, Yinchuan, China

¹⁰. Department of Hepatology, The Third People’s Hospital of Tibet Autonomous Region, Lhasa, China

¹¹. Department of Infectious Diseases, Nanjing Drum Tower Hospital, The Affiliated Hospital of Medical School, Nanjing University, Nanjing, China

¹². Department of Infectious Diseases, Hunan Key Laboratory of Viral Hepatitis, Xiangya Hospital, Central South University, Changsha, China

¹³. Department of Infectious Diseases, The First People’s Hospital of Changde City, Changde, China

¹⁴. Department of Infectious Disease, Lishui City People’s Hospital, Lishui, China

¹⁵. Hepatology Department of Infectious Diseases Center, The First People’s Hospital of Huaihua, Huaihua, China

¹⁶. Department of Hepatology, Shenyang 739 Hospital, Shenyang, China

¹⁷. Liver Cirrhosis Treatment Center, Nanjing Hospital Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing, China

¹⁸. Department of Gastroenterology, Datong City Fourth People’s Hospital, Datong, China

¹⁹. Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, China

²⁰. Department of Hepatology, Third People’s Hospital of Linfen City, Linfen, China

²¹. Department of Gastroenterology, The First Hospital of China Medical University, Shenyang, China

²². Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, China

²³. Department of Hepatology, Shenzhen Third People’s Hospital, National Clinical Research Center for Infectious Disease, The Second Affiliated Hospital, School of Medicine, Southern University of Science and Technology, Shenzhen, China

²⁴. Department of Gastroenterology, The First Affiliated Hospital of Dalian Medical University, Dalian, China

²⁵. Department of Gastroenterology, The Second Affiliated Hospital of Baotou Medical College, Baotou, China

²⁶. Department of Gastroenterology, Wuzhong People’s Hospital, Wuzhong, China

²⁷. Department of Severe Hepatology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China

²⁸. Department of Gastroenterology, Central hospital of Dandong, Dandong, China

²⁹. Department of Gastroenterology Liver Diseases, Chongqing Public Health Medical Center, Chongqing, China

³⁰. Liver Disease Diagnosis and Treatment Center, Yiyang Fourth People’s Hospital, Yiyang, China

³¹. Qingdao Sixth People’s Hospital, Qingdao, China

³². Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and Central Virginia Veterans Healthcare System, Richmond, Virginia, USA

jasmohan.bajaj@vcuhealth.org

fswang302@163.com

fjunliang@163.com

qixiaolong@vip.163.com

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Abstract

Minimal hepatic encephalopathy (MHE) has a substantial impact on the clinical outcomes and quality of life (QOL) of patients with cirrhosis. However, timely diagnosis and intervention are challenging due to sophisticated diagnostic methods. In this study, 673 healthy controls and 905 patients with cirrhosis were screened, and 660 healthy controls and 757 patients with cirrhosis, divided into the test (292 patients) and validation (465 patients) cohort, were analyzed after screening. A diagnostic model of the Stroop test (Stroop-CN) was constructed by multivariate linear regression based on the results of healthy controls. The prevalence of MHE and the comparison results with psychometric hepatic encephalopathy score through the Stroop-CN model were stable in the test and validation cohorts. Moreover, the prevalence of MHE remained significantly higher in patients with worse disease conditions marked as high Child–Pugh grades and the Model for End-stage Liver Disease and Sodium (MELD-Na) scores in the test and validation cohort. The EuroQol 5-D questionnaire revealed that patients with MHE had a worse QOL than those without MHE both in the test and validation cohort. In conclusion, an easy and practical Stroop-CN model for MHE diagnosis based on the EncephalApp is established. It is found that a considerable number of Chinese patients with cirrhosis experience MHE, which significantly impacts their QOL.

Keywords

cirrhosis / minimal hepatic encephalopathy / quality of life / Stroop test

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Xiaoyan Li, Shanghao Liu, Ying Guo, Hongmei Zu, Huiling Xiang, Shaoqi Yang, Xiaoning Zhang, Fanping Meng, Yangzhen Bianba, Jie Li, Fei Liu, Chuang Lei, Jiaojian Lv, Qiao-hua Yang, Wei Fu, Wei Ye, Jiafang Chen, Yanjing Gao, Caiyun Wu, Ningning Wang, Qi Zheng, Fang Wang, Jiali Yu, Jing Wang, Xiaoting Yang, Xiangmei Wang, Yayuan Liu, Xuelan Zhao, Chenxi Wu, Wei Gou, Jasmohan S. Bajaj, Fu-Sheng Wang, Junliang Fu, Xiaolong Qi. Detection of minimal hepatic encephalopathy in patients with cirrhosis based on the Stroop-CN model (NCRCID-CHESS 2106): a prospective multicenter study. MedComm, 2024, 5(8): e627 DOI:10.1002/mco2.627

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