Serum zinc levels as predictors of covert hepatic encephalopathy in patients with liver cirrhosis.

IF 6.9 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Journal of Gastroenterology Pub Date : 2024-10-16 DOI:10.1007/s00535-024-02160-5
Naoto Soma, Yoshihito Uchida, Jun-Ichi Kouyama, Kayoko Naiki, Nanase Usui, Aya Sato, Shunsuke Yamada, Shohei Tsuji, Satsuki Ando, Kayoko Sugawara, Masamitsu Nakao, Nobuaki Nakayama, Yukinori Imai, Tomoaki Tomiya, Suguru Mizuno, Satoshi Mochida
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Abstract

Background: Covert hepatic encephalopathy (CHE) significantly impacts the quality of life and prognosis in patients with liver cirrhosis. This study aims to analyze the prevalence and risk factors of CHE to identify high-risk patients who would benefit from therapeutic interventions.

Methods: This single-center, retrospective observational study included 126 patients without a history of overt hepatic encephalopathy (OHE). CHE was defined as a score above the age-based cutoff value in the Stroop test. Factors associated with the occurrence of CHE and the subsequent development of OHE were evaluated.

Results: CHE was detected in 47 patients (37.3%). A multiple logistic regression analysis identified serum zinc levels (per + 1 µg/dL, odds ratio 0.95, P = 0.0007) as the only risk factor associated with CHE, with a cutoff value of 60 µg/dL (AUC 0.71, P = 0.0001). Neither blood ammonia levels nor liver function were predictive of CHE. During a median observation period of 211 days, OHE developed in 18 patients (14.3%). The administration of more than 20 mg of furosemide was identified as a risk factor for developing OHE (hazard ratio 23.52, P = 0.0207).

Conclusion: Cirrhotic patients with serum zinc levels below 60 µg/dL exhibit a high risk of developing CHE, regardless of blood ammonia levels. These patients face a significant risk of developing OHE. Therefore, early zinc supplementation is recommended for the prevention of OHE, particularly for those prescribed 20 mg or more of furosemide.

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预测肝硬化患者隐匿性肝性脑病的血清锌水平。
背景:隐匿性肝性脑病(CHE)严重影响肝硬化患者的生活质量和预后。本研究旨在分析隐匿性肝性脑病的发病率和风险因素,以确定可从治疗干预中获益的高危患者:这项单中心回顾性观察研究纳入了 126 名无明显肝性脑病(OHE)病史的患者。CHE的定义是在Stroop测试中得分超过基于年龄的临界值。研究评估了与CHE发生及随后发展为OHE相关的因素:结果:47 名患者(37.3%)检测出 CHE。多元逻辑回归分析发现,血清锌水平(per + 1 µg/dL,几率比 0.95,P = 0.0007)是与 CHE 相关的唯一风险因素,临界值为 60 µg/dL(AUC 0.71,P = 0.0001)。血氨水平和肝功能均不能预测CHE。在中位 211 天的观察期内,18 名患者(14.3%)出现了 OHE。服用 20 毫克以上的呋塞米被认为是发生 OHE 的风险因素(危险比 23.52,P = 0.0207):结论:无论血氨水平如何,血清锌水平低于 60 µg/dL 的肝硬化患者罹患 CHE 的风险很高。这些患者面临着罹患 OHE 的巨大风险。因此,建议尽早补锌以预防 OHE,尤其是那些服用 20 毫克或更多呋塞米的患者。
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来源期刊
Journal of Gastroenterology
Journal of Gastroenterology 医学-胃肠肝病学
CiteScore
12.20
自引率
1.60%
发文量
99
审稿时长
4-8 weeks
期刊介绍: The Journal of Gastroenterology, which is the official publication of the Japanese Society of Gastroenterology, publishes Original Articles (Alimentary Tract/Liver, Pancreas, and Biliary Tract), Review Articles, Letters to the Editors and other articles on all aspects of the field of gastroenterology. Significant contributions relating to basic research, theory, and practice are welcomed. These publications are designed to disseminate knowledge in this field to a worldwide audience, and accordingly, its editorial board has an international membership.
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