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. 2024 Dec 25;15(1):23.
doi: 10.3390/diagnostics15010023.

Benefits of Liver Volume and Serum Zinc Level Assessment for the Screening of Covert Hepatic Encephalopathy in Patients with Child-Pugh Class A Cirrhosis

Masanori Fukushima  1 , Hisamitsu Miyaaki  1 , Ryu Sasaki  1 , Yasuhiko Nakao  1 , Masafumi Haraguchi  1 , Kosuke Takahashi  1 , Eisuke Ozawa  1 , Satoshi Miuma  1 , Kazuhiko Nakao  1
Affiliations

Benefits of Liver Volume and Serum Zinc Level Assessment for the Screening of Covert Hepatic Encephalopathy in Patients with Child-Pugh Class A Cirrhosis

Masanori Fukushima et al. Diagnostics (Basel). .

Abstract

Background/Objectives: Covert hepatic encephalopathy (CHE) is associated with decreased quality of life. Detection of Child-Pugh class A is necessary for its early diagnosis. This study aimed to establish a simple diagnostic method of CHE in patients with Child-Pugh class A. Methods: One hundred patients with liver cirrhosis without overt hepatic encephalopathy and sixty-eight with liver cirrhosis and Child-Pugh class A who visited our institution were enrolled. CHE was diagnosed using number connection test B in the neuropsychiatric test (NPT). Clinical data were compared. Results: The liver volume/body surface area ratio (LV/BSA) was associated with CHE in patients with all-cause and Child-Pugh class A liver cirrhosis. Multiple logistic regression analysis revealed that low LV/BSA and low serum zinc (Zn) levels were significantly associated with CHE in Child-Pugh class A liver cirrhosis. The best cutoff values in the receiver operating characteristic curve analysis showed that the complication rate of CHE was 54.8% in patients with LV/BSA < 620 mL/m2, which was 2.9 times higher than that in patients with larger liver volume. Referring to the cutoff values for LV/BSA and Zn (<70 µg/dL), in cases with LV/BSA < 620 mL/m2 and Zn < 70 µg/dL, 64.2% had CHE, whereas in cases with LV/BSA ≥ 620 mL/m2 and Zn ≥ 70 µg/dL, 94.5% did not have CHE. Conclusions: Liver volume can be used as a risk assessment tool for CHE. LV/BSA and serum Zn levels are considered effective diagnostic tools for CHE, serving as alternatives to NPT in patients with Child-Pugh class A liver cirrhosis.

Keywords: covert hepatic encephalopathy; liver cirrhosis; liver volume; zinc.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Incidence of CHE according to Child–Pugh classes. The worse the Child–Pugh class is, the higher the incidence of CHE. CHE—covert hepatic encephalopathy.
Figure 2
Figure 2
CHE in Child–Pugh class A correlates with liver volume. (a) Receiver operating characteristic curve of LV/BSA in Child–Pugh class A. (b) Setting the cutoff value at 620 mL/m2, the incidence of CHE was 2.9 times higher in cases below the cutoff value. LV/BSA—liver volume/body surface area; AUC—area under the curve; CHE—covert hepatic encephalopathy.
Figure 3
Figure 3
Representative image showing differences in liver volume. CHE—covert hepatic encephalopathy; HCV—hepatitis C virus; HBV—hepatitis B virus; LV/BSA—liver volume/body surface area.
Figure 4
Figure 4
CHE prediction using liver volume and serum zinc levels. Low LV/BSA (<620 mL/m2) and low zinc level (<70 µg/dL) were associated with high incidence of CHE. CHE—covert hepatic encephalopathy; LV/BSA—liver volume/body surface area.
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