A cross-sectional observational study revealed a significant correlation between serum zinc levels and the severity of hepatic encephalopathy in patients with liver cirrhosis, suggesting zinc deficiency may serve as both a marker for disease progression and potential therapeutic target.
In the study, published in the Journal of Family Medicine and Primary Care, researchers examined 150 cirrhotic patients with hepatic encephalopathy (HE) at a tertiary care center in Jharkhand, India. The researchers found that lower serum zinc levels were significantly associated with higher West Haven Classification (WHC) grades of encephalopathy (P < .00001) and more advanced Child-Pugh Classification (CPC) of cirrhosis (P < .00001).
The investigation demonstrated that patients who did not survive had markedly lower mean serum zinc levels compared to survivors (35.56 ± 11.65 vs 48.36 ± 10.91 mcg/dL, P < .0001). Additionally, the researchers identified a strong positive correlation between serum zinc and albumin levels (r = 0.88, P = .048), suggesting hypoalbuminemia may serve as a surrogate marker for zinc deficiency.
Clinical presentations varied widely, with abdominal distension being most common (72%), followed by pedal edema (66%), icterus (61.33%), fever (51.33%), and constipation (48.66%). The most frequent precipitating factor for HE was infection (52.66%), particularly lower respiratory tract infections (22%) and spontaneous bacterial peritonitis (18.66%).
The study population included predominantly males (86%) with a mean age of 44.6 ± 6.34 years. Most of the patients (68%) were between 30 and 50 years old. Chronic alcoholism was identified as the leading cause of cirrhosis (61.33%), followed by hepatitis B virus infection (12%).
When examining HE severity, 32% of the patients presented with WHC grade I, 32% with grade II, 16% with grade III, and 8% with grade IV. The remaining 12% were classified as grade 0. Zinc levels demonstrated a consistent inverse relationship with HE severity, showing statistically significant differences between most WHC grades.
The Child-Pugh classification distribution revealed 52% of patients in Class C, 40% in Class B, and 8% in Class A. Zinc deficiency was more pronounced in advanced cirrhosis, with CPC class C patients showing significantly lower zinc levels compared with classes A and B.
Detailed zinc level comparisons between WHC grades showed significant differences: grade 4 vs grade 3 (28.23 vs 35.82 mcg/dL, P = .0251), grade 4 vs grade 2 (28.23 vs 46.31 mcg/dL, P < .0001), and grade 4 vs grade 1 (28.23 vs 53.28 mcg/dL, P < .0001).
The mortality rate was 14%, with higher mortality observed in patients with more severe grades of HE (OR = 9.72, P < .0001). Among survivors, the mean serum zinc level was 48.36 ± 10.91 mcg/dL compared with 35.56 ± 11.65 mcg/dL in nonsurvivors.
The researchers recommended zinc level screening for all cirrhotic patients with HE, particularly those with hypoalbuminemia. The study was conducted under institutional ethics committee approval with detailed patient consent protocols.
The authors declared having no competing interests.
