Association between laboratory values and covert hepatic encephalopathy in patients with cirrhosis: a multicenter retrospective study

Abstract

Covert hepatic encephalopathy (CHE) is a subclinical complication of liver cirrhosis that is associated with poor prognosis. Identification of practical biomarkers for CHE is therefore essential in clinical practice. To clarify factors associated with CHE, we conducted a multicenter retrospective study involving 402 patients with cirrhosis from 17 institutions. CHE was diagnosed using the Stroop test. Laboratory parameters, including serum albumin and 25-hydroxyvitamin D₃ (25[OH]D₃), were analyzed to identify risk factors for CHE.

The cohort consisted of 233 men and 169 women, with a median age of 69 years. Esophageal varices (EV) were present in 45% of patients. Multivariate analysis identified low 25(OH)D₃ levels (<16.5 ng/ml) and the presence of EV as independent predictors of CHE (p<0.05). When the analysis was restricted to laboratory markers, low serum albumin (<3.7 g/dl) and low 25 (OH) D₃ levels remained significant. The prevalence of CHE increased with the accumulation of these risk factors: 59.2% in patients with low 25(OH)D₃ and EV, 53.8% in those with low albumin and low 25(OH)D₃, and 66.7% in those with all three factors.

In conclusion, low serum 25(OH)D₃ and albumin levels, as well as the presence of EV, are significantly associated with CHE in patients with cirrhosis. Early identification and monitoring of these risk factors may facilitate timely diagnosis and management of CHE.