Usefulness of serum zinc levels in the diagnosis of complications of liver cirrhosis associated with portal hypertension

Abstract

Covert hepatic encephalopathy (CHE) impairs quality of life and prognosis in cirrhotic patients. This study aimed to identify risk factors for CHE and to stratify patients at high risk for overt hepatic encephalopathy (HE) who may benefit from early therapeutic intervention. A total of 145 cirrhotic patients without a history or treatment for overt HE were enrolled and classified into CHE (n=91) and no-CHE (n=54) groups. CHE was diagnosed when performance on at least one neuropsychological test, such as the Stroop or number connection test, exceeded the age-adjusted cutoff value. The prevalence of CHE was 62.8%. Compared with the no-CHE group, patients with CHE had significantly lower serum zinc and albumin levels. Multivariate logistic regression identified serum zinc level as an independent determinant, with a cutoff of 74 μg/dl. Subclinical zinc deficiency (<74 μg/dl) showed 55.6% sensitivity and 81.5% specificity for CHE detection. Blood ammonia level and liver functional reserve were not predictive. Patients with zinc ≥ 74 μg/dl had a significantly lower CHE prevalence and better hepatic functional reserve. Subclinical zinc deficiency is closely associated with CHE occurrence in cirrhosis, and zinc measurement may aid in early CHE detection and patient selection for neuropsychological testing.Usefulness of Serum Zinc Levels in the Diagnosis of Complications of Liver Cirrhosis Associated with Portal Hypertension