Tesis

Kesahihan dan Keandalan serta Nilai Diagnostik Encephalapp Stroop Test Dalam Mendiagnosis Ensefalopati Hepatikum Covert = Validity, Reliability and Diagnostic Value of Encephalapp Stroop Test in Diagnosing Covert Hepatic Encephalopathy.

Latar Belakang: Ensefalopati hepatikum (EH) covert merupakan spektrum teringan EH yang sulit dideteksi, namun diasosiasikan dengan penurunan kualitas hidup. Belum ada baku emas untuk mendeteksinya. Adanya aplikasi EncephalApp Stroop Test (EST) yang mudah, cepat, dan tersedia luas untuk diagnosis EH covert diharapkan dapat diterapkan di Indonesia. Tujuan: Menguji kesahihan, keandalan, serta uji diagnostik EST untuk mendiagnosis ensefalopati hepatikum covert di Indonesia. Metode: Penelitian ini merupakan uji potong lintang untuk mendapatkan nilai area under the curve (AUC), titik potong, sensitivitas, spesifisitas, predictive value, likelihood ratio dan post test probability EST, dibandingkan dengan Psychometric Hepatic Encephalopathy Score (PHES) dan Critical Flicker Frequency (CFF). Sebelumnya terlebih dahulu dilakukan translasi dan uji kesahihan serta keandalan. Penelitian dilakukan selama bulan Agustus sampai dengan September 2018. Populasi target penelitian ini adalah pasien sirosis hati di Jakarta. Semua pasien terlebih dahulu menjalani pemeriksaan MMSE (Mini Mental State Examination) untuk menyingkirkan gangguan kognitif dan Ishihara Test untuk menyingkirkan buta warna. Hasil: Terdapat 30 subjek yang mengikuti uji kesahihan dan keandalan, serta 80 subjek yang mengikut uji diagnostik. Uji keandalan dan kesahihan menunjukkan nilai Cronbach’s Alpha 0,942 dan koefisien korelasi terbaik 0,82. Uji diagnosis menunjukkan parameter terbaik OnTime+OffTime dengan AUC: 0,897 (95% Interval Kepercayaan (IK)=82,9% - 96,5%); sensitivitas 88,6%; spesifisitas 80%; Postiive Predictive Value (PPV)=0,77; Negative Predictive Value (NPV)=0,9; Positive Likelihood Ratio (LK+)=4,4; Negative Likelihood Ratio (LK-)=1.4; Positive Post-Test Probability=0,775; Negative Post-Test Probability=0,1; dan titik potong ≥ 188,82 detik. Simpulan: EST sahih dan andal, dengan nilai diagnostik yang baik dalam mendiagnosis ensefalopati hepatikum covert pada pasien sirosis hati.

Kata Kunci: Ensefalopati hepatikum covert, sirosis hati, EncephalApp Stroop Test, riwayat ensefalopati hepatikum, Critical Flicker Frequency (CFF), Psychometric Hepatic Encephalopathy Score (PHES).


Background: Covert hepatic encephalopathy (HE) is the mildest HE spectrum that is difficult to detect, but associated with decrease in quality of life. Currently no gold standard to detect covert HE. EncephalApp Stroop Test (EST) as a newer diagnostic tool is easier, faster and its ease of availability is expected to be applied in Indonesia for covert HE detection. Objective: To validate, test the reliability and diagnostic ability of EncephalApp Stroop Test to diagnose covert HE in Indonesia. Methods: This study is a cross-sectional test, conducted from August to September 2018, targeted at patient with liver cirrhosis in Jakarta, obtaining area under the curve (AUC), sensitivity, specificity, cut-off point, predictive value, likelihood ratio, and post-test probability of the EST, compared to PHES and CFF. Translation of the EST were first carried out, and validity and reliability tests were done before diagnostic study. All patients first underwent an MMSE (Mini Mental State Examination) examination to rule out the possibility cognitive impairments and Ishihara Test to rule out color blindness. Results: Thirty subjects participated in validity and reliability tests, and eighty in diagnostic tests. The translated application showed excellent internal consistency (Cronbach's Alpha of 0.942) and correlation coefficient of 0.82. The diagnostic study showed OnTime + OffTime as the best parameter (AUC=0.897 (95% CI=82.9% - 96.5%); sensitivity=88.6%; specificity=80%; positive predictive value (PPV)=0.77; negative predictive value (NPV)=0.9; positive likelihood ratio (LK+)=4.4; negative likelihood ratio (LK-)=1.4; positive post-test probability=0,775; negative post-test probability=0,1; and cut-off point ≥ 188.82 seconds. Conclusion: The EST is valid, reliable, and showed good ability to diagnose covert hepatic encephalopathy in liver cirrhosis patient in Indonesia.

Keywords: Covert hepatic encephalopathy, liver cirrhosis, EncephalApp Stroop Test, history of hepatic encephalopathy, Critical Flicker Frequency (CFF), Psychometric Hepatic Encephalopathy Score (PHES).