AIMTo evaluate the reversibility of minimal hepatic encephalopathy (MHE) following liver transplantation (LT) in Egyptian cirrhotic patients. METHODSThis prospective study included twenty patients with biopsy-proven l...AIMTo evaluate the reversibility of minimal hepatic encephalopathy (MHE) following liver transplantation (LT) in Egyptian cirrhotic patients. METHODSThis prospective study included twenty patients with biopsy-proven liver cirrhosis listed for LT and twenty age- and sex-matched healthy control subjects. All underwent neuro-psychiatric examination, laboratory investigations, radiological studies and psychometric tests including trail making test A (TMT A), TMT B, digit symbol test and serial dotting test. The psychometric hepatic encephalopathy score (PHES) was calculated for patients to diagnose MHE. Psychometric tests were repeated six months following LT in the cirrhotic patient group. RESULTSBefore LT, psychometric tests showed highly significant deficits in cirrhotic patients in comparison to controls (P P P P = 0.005). More patients in whom reversal of MHE was observed had a pre-transplant MELD score CONCLUSIONReversal of MHE in cirrhotic patients could be achieved by LT, especially in those with a MELD score展开更多
Background: Minimal hepatic encephalopathy (MHE) is defined as hepatic encephalopathy (HE) without symptoms on clinical/neurological examination, but with deficits in some cognitive areas that can only be measured by ...Background: Minimal hepatic encephalopathy (MHE) is defined as hepatic encephalopathy (HE) without symptoms on clinical/neurological examination, but with deficits in some cognitive areas that can only be measured by neuropsychometric testing. Aim: Our aim was to study serum zinc levels in cirrhotic patients with and without MHE and correlate it with the results of neuropsychological tests and P300 event related potential. Patients and Methods: Fifty-five patients with liver cirrhosis were recruited for the present study. All patients were subjected to full history taking, clinical examination, abdominal ultrasonography, laboratory investigations including liver function tests and serum zinc, psychometric studies (line tracing test and serial dotting test) and P300 event related potential. According to the results of psychometric studies and P300 event related potential, the patients were divided into 3 groups in addition to the control group. Results: Among the 55 patients included in the study, 30 patients had no clinical evidence of HE and 25 patients had overt HE with different grades. In patients with no clinical evidence of HE, psychometric tests and P300 event related potential revealed that 13 patients had MHE, while 17 had no HE. There were significantly lower serum zinc levels in patients with MHE and in cirrhotic patients without HE compared with the healthy controls. Also, zinc levels were significantly lower in higher grades of hepatic encephalopathy. Serum zinc levels showed positive correlation with serum albumin levels and inverse correlation with serial dotting test and P300 latency. Conclusion: Reduced serum zinc level and prolonged P300 latency can serve as predictors of minimal hepatic encephalopathy in cirrhotic patients. Zinc deficiency is common in cirrhotic patients with MHE. These findings may have important prognostic and therapeutic implications in MHE and overt HE patients with zinc deficiency.展开更多
AIM To understand the role of nutritional status in cirrhotic patients without clinical porto-systemic encephalopathy (PSE).METHODS Fifty-one non-alcoholic patients with cirrhosis without PSE were studied prospectivel...AIM To understand the role of nutritional status in cirrhotic patients without clinical porto-systemic encephalopathy (PSE).METHODS Fifty-one non-alcoholic patients with cirrhosis without PSE were studied prospectively and compared with 20 healthy volunteers. The nutritional evaluation included serum prealbumin, albumin, transferrin, body mass index (BMI), mid-arm muscle circumference (MAMC), and grip power. The occurrence of subclinical PSE (SPSE) was defined when N20-N65 inter-peak latencies of median nerve-stimulated somatosensory evoked potentials were ＞2.5 standard deviations of control means. Blood chemistries were tested within 12h of somatosensory evoked potentials test and nutritional evaluation.RESULTS Twenty-five, 17 and 9 cirrhotic patients were graded as Child-Pugh class A, B, and C, respectively. Twenty-four (47.1%) patients developed SPSE. Cirrhotic patients with SPSE had lower serum albumin (2.8g/dL±0.5g/dL vs 3.1g/dL±0.7g/dL, P＜0.001) levels than those without SPSE. Prealbumin (10.6mg/dL±5.7mg/dL vs 12.5mg/dL±5.8mg/dL), transferrin (164mg/dL±46mg/dL vs 178mg/dL±58mg/dL), BMI (23.7kg/m2±2.7kg/m2 vs 25.3kg/m2±3.6kg/m2), MAMC (22.2cm±2.6cm vs 22.7cm±3.5cm), and grip power (26.3kg±6.4kg vs 26.9kg±6.8kg) were not different between cirrhotic patients with and without SPSE. N20-N65 inter-peak latencies were correlated with serum albumin levels (P=0.01) but not with prealbumin, transferrin, BMI, MAMC, or grip power. Serum albumin, prealbumin and transferrin levels were different among cirrhotic patients with Child-Pugh classes A, B, and C (P＜0.05). BMI, MAMC, and grip power were not different among Child-Pugh classes A, B and C.CONCLUSION Our data suggest that serum albumin level is a simple test in the evaluation of nutritional status in patients with cirrhosis.展开更多
文摘AIMTo evaluate the reversibility of minimal hepatic encephalopathy (MHE) following liver transplantation (LT) in Egyptian cirrhotic patients. METHODSThis prospective study included twenty patients with biopsy-proven liver cirrhosis listed for LT and twenty age- and sex-matched healthy control subjects. All underwent neuro-psychiatric examination, laboratory investigations, radiological studies and psychometric tests including trail making test A (TMT A), TMT B, digit symbol test and serial dotting test. The psychometric hepatic encephalopathy score (PHES) was calculated for patients to diagnose MHE. Psychometric tests were repeated six months following LT in the cirrhotic patient group. RESULTSBefore LT, psychometric tests showed highly significant deficits in cirrhotic patients in comparison to controls (P P P P = 0.005). More patients in whom reversal of MHE was observed had a pre-transplant MELD score CONCLUSIONReversal of MHE in cirrhotic patients could be achieved by LT, especially in those with a MELD score
文摘Background: Minimal hepatic encephalopathy (MHE) is defined as hepatic encephalopathy (HE) without symptoms on clinical/neurological examination, but with deficits in some cognitive areas that can only be measured by neuropsychometric testing. Aim: Our aim was to study serum zinc levels in cirrhotic patients with and without MHE and correlate it with the results of neuropsychological tests and P300 event related potential. Patients and Methods: Fifty-five patients with liver cirrhosis were recruited for the present study. All patients were subjected to full history taking, clinical examination, abdominal ultrasonography, laboratory investigations including liver function tests and serum zinc, psychometric studies (line tracing test and serial dotting test) and P300 event related potential. According to the results of psychometric studies and P300 event related potential, the patients were divided into 3 groups in addition to the control group. Results: Among the 55 patients included in the study, 30 patients had no clinical evidence of HE and 25 patients had overt HE with different grades. In patients with no clinical evidence of HE, psychometric tests and P300 event related potential revealed that 13 patients had MHE, while 17 had no HE. There were significantly lower serum zinc levels in patients with MHE and in cirrhotic patients without HE compared with the healthy controls. Also, zinc levels were significantly lower in higher grades of hepatic encephalopathy. Serum zinc levels showed positive correlation with serum albumin levels and inverse correlation with serial dotting test and P300 latency. Conclusion: Reduced serum zinc level and prolonged P300 latency can serve as predictors of minimal hepatic encephalopathy in cirrhotic patients. Zinc deficiency is common in cirrhotic patients with MHE. These findings may have important prognostic and therapeutic implications in MHE and overt HE patients with zinc deficiency.
文摘AIM To understand the role of nutritional status in cirrhotic patients without clinical porto-systemic encephalopathy (PSE).METHODS Fifty-one non-alcoholic patients with cirrhosis without PSE were studied prospectively and compared with 20 healthy volunteers. The nutritional evaluation included serum prealbumin, albumin, transferrin, body mass index (BMI), mid-arm muscle circumference (MAMC), and grip power. The occurrence of subclinical PSE (SPSE) was defined when N20-N65 inter-peak latencies of median nerve-stimulated somatosensory evoked potentials were ＞2.5 standard deviations of control means. Blood chemistries were tested within 12h of somatosensory evoked potentials test and nutritional evaluation.RESULTS Twenty-five, 17 and 9 cirrhotic patients were graded as Child-Pugh class A, B, and C, respectively. Twenty-four (47.1%) patients developed SPSE. Cirrhotic patients with SPSE had lower serum albumin (2.8g/dL±0.5g/dL vs 3.1g/dL±0.7g/dL, P＜0.001) levels than those without SPSE. Prealbumin (10.6mg/dL±5.7mg/dL vs 12.5mg/dL±5.8mg/dL), transferrin (164mg/dL±46mg/dL vs 178mg/dL±58mg/dL), BMI (23.7kg/m2±2.7kg/m2 vs 25.3kg/m2±3.6kg/m2), MAMC (22.2cm±2.6cm vs 22.7cm±3.5cm), and grip power (26.3kg±6.4kg vs 26.9kg±6.8kg) were not different between cirrhotic patients with and without SPSE. N20-N65 inter-peak latencies were correlated with serum albumin levels (P=0.01) but not with prealbumin, transferrin, BMI, MAMC, or grip power. Serum albumin, prealbumin and transferrin levels were different among cirrhotic patients with Child-Pugh classes A, B, and C (P＜0.05). BMI, MAMC, and grip power were not different among Child-Pugh classes A, B and C.CONCLUSION Our data suggest that serum albumin level is a simple test in the evaluation of nutritional status in patients with cirrhosis.
