Suraj Hiwarkar, M. Holay, Bhiwagade Rahul, Patil Prashant
{"title":"Study of serum zinc level in liver cirrhosis and its correlation with stages of hepatic encephalopathy","authors":"Suraj Hiwarkar, M. Holay, Bhiwagade Rahul, Patil Prashant","doi":"10.4103/injms.injms_9_23","DOIUrl":null,"url":null,"abstract":"Background: Zinc increases the natural defense of reactive oxygen radicals; Zinc also acts as an antioxidant, an anti-apoptotic agent, a cofactor for DNA synthesis, and an anti-inflammatory agent. Hence, deficient zinc levels seem to have an effect in the pathogenesis of hepatic encephalopathy (HE). Aims: This prospective observational study was done to assess serum zinc levels in cases of liver cirrhosis with decompensated liver disease (DCLD) and to see the correlation of serum zinc levels with stages of HE and patients' outcome. Materials and Methods: This prospective observational study was conducted at a tertiary care institution in Central India. Total 66 cases of liver cirrhosis with DCLD were studied. Fifty healthy controls were enrolled. All cases were evaluated for serum zinc levels, and all were divided further according to the class of liver cirrhosis and stages of HE. The association between serum zinc level and stages of HE and outcome was studied. The data were analyzed with SPSS software version 22. Results: The mean age of the cases at presentation was 45.67 ± 8.73 years. The M: F ratio was 10:1. The mean serum zinc level in controls was 104.16 ± 22.60 μg/dl, while in cases, it was 47.68 ± 16.72 μg/dl. It was significantly low in cases as compared to the controls, P < 0.0001. An inverse correlation was observed between serum zinc and West Haven classification grading of HE. There was found a direct correlation between serum zinc level and serum albumin. The lesser the serum albumin, the lesser the serum zinc level. P <0.0001 was highly significant. The mean serum zinc level was 57.67 μg/dl in survivors 40 cases (60.61%) as compared to 32.30 μg/dl in nonsurvivors 26 (39.30%). Low serum zinc level was associated with high mortality. P <0.0001 was statistically highly significant. Conclusion: Low serum zinc is associated with cirrhosis of the liver, DCLD, and high incidence of HE. Hence, all patients of cirrhosis liver with hypoalbuminemia and HE should be evaluated for low serum zinc. Low serum zinc in HE was associated with high mortality. The present study could not establish a causal relationship between low serum zinc and liver cirrhosis with DCLD having HE. Whether correction of zinc in these cases can prevent worsening, HE needs further evaluation.","PeriodicalId":43811,"journal":{"name":"Indian Journal of Medical Specialities","volume":null,"pages":null},"PeriodicalIF":0.2000,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Indian Journal of Medical Specialities","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.4103/injms.injms_9_23","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Zinc increases the natural defense of reactive oxygen radicals; Zinc also acts as an antioxidant, an anti-apoptotic agent, a cofactor for DNA synthesis, and an anti-inflammatory agent. Hence, deficient zinc levels seem to have an effect in the pathogenesis of hepatic encephalopathy (HE). Aims: This prospective observational study was done to assess serum zinc levels in cases of liver cirrhosis with decompensated liver disease (DCLD) and to see the correlation of serum zinc levels with stages of HE and patients' outcome. Materials and Methods: This prospective observational study was conducted at a tertiary care institution in Central India. Total 66 cases of liver cirrhosis with DCLD were studied. Fifty healthy controls were enrolled. All cases were evaluated for serum zinc levels, and all were divided further according to the class of liver cirrhosis and stages of HE. The association between serum zinc level and stages of HE and outcome was studied. The data were analyzed with SPSS software version 22. Results: The mean age of the cases at presentation was 45.67 ± 8.73 years. The M: F ratio was 10:1. The mean serum zinc level in controls was 104.16 ± 22.60 μg/dl, while in cases, it was 47.68 ± 16.72 μg/dl. It was significantly low in cases as compared to the controls, P < 0.0001. An inverse correlation was observed between serum zinc and West Haven classification grading of HE. There was found a direct correlation between serum zinc level and serum albumin. The lesser the serum albumin, the lesser the serum zinc level. P <0.0001 was highly significant. The mean serum zinc level was 57.67 μg/dl in survivors 40 cases (60.61%) as compared to 32.30 μg/dl in nonsurvivors 26 (39.30%). Low serum zinc level was associated with high mortality. P <0.0001 was statistically highly significant. Conclusion: Low serum zinc is associated with cirrhosis of the liver, DCLD, and high incidence of HE. Hence, all patients of cirrhosis liver with hypoalbuminemia and HE should be evaluated for low serum zinc. Low serum zinc in HE was associated with high mortality. The present study could not establish a causal relationship between low serum zinc and liver cirrhosis with DCLD having HE. Whether correction of zinc in these cases can prevent worsening, HE needs further evaluation.
期刊介绍:
The Indian Journal of Medical Specialities is an all-encompassing peer-reviewed quarterly journal. The journal publishes scholarly articles, reviews, case reports and original research papers from medical specialities specially pertaining to clinical patterns and epidemiological profile of diseases. An important highlight is the emphasis on undergraduate and postgraduate medical education including various aspects of scientific paper-writing. The journal gives priority to research originating from the developing world, including from the tropical regions of the world. The journal also publishes special issues on health topics of current interest. The Indian Journal of Medical Specialities is one of the very few quality multispeciality scientific medical journals.