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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.
See this image and copyright information in PMC

References

    1. Kondo Y., Iwasa M., Kawaratani H., Miyaaki H., Hanai T., Kon K., Hirano H., Shimizu M., Yoshiji H., Okita K., et al. Proposal of Stroop test cut-off values as screening for neuropsychological impairments in cirrhosis: A Japanese multicenter study. Hepatol. Res. 2021;51:674–681. doi: 10.1111/hepr.13629. - DOI - PubMed
    1. Miyaaki H., Hiraoka A., Haraguchi M., Uojima H., Kawaratani H., Hiramatsu A., Hanai T., Hiasa Y., Yoshiji H., Okita K., et al. Proposal for new sleep disorder criteria in patients with chronic liver disease: Influence of liver-related complications. Hepatol. Res. 2022;52:364–370. doi: 10.1111/hepr.13731. - DOI - PubMed
    1. Miwa T., Hanai T., Nishimura K., Maeda T., Tajirika S., Imai K., Suetsugu A., Takai K., Yamamoto M., Shimizu M. A simple covert hepatic encephalopathy screening model based on blood biochemical parameters in patients with cirrhosis. PLoS ONE. 2022;17:e0277829. doi: 10.1371/journal.pone.0277829. - DOI - PMC - PubMed
    1. Gairing S.J., Mangini C., Zarantonello L., Gioia S., Nielsen E.J., Danneberg S., Gabriel M., Ehrenbauer A.F., Bloom P.P., Ripoll C., et al. Prevalence of minimal hepatic encephalopathy in patients with liver cirrhosis: A multicenter study. Am. J. Gastroenterol. 2023;118:2191–2200. doi: 10.14309/ajg.0000000000002251. - DOI - PubMed
    1. Zhu J.Y., Leng X.S., Dong N., Qi G.Y., Du R.Y. Measurement of liver volume and its clinical significance in cirrhotic portal hypertensive patients. World J. Gastroenterol. 1999;5:525–526. doi: 10.3748/wjg.v5.i6.525. - DOI - PMC - PubMed

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