Liver Failure/Cirrhosis/Portal Hypertension
Different biochemical correlates for different neuropsychiatric abnormalities in patients with cirrhosis†
Article first published online: 3 JAN 2011
Copyright © 2010 American Association for the Study of Liver Diseases
Volume 53, Issue 2, pages 558–566, February 2011
How to Cite
Montagnese, S., Biancardi, A., Schiff, S., Carraro, P., Carlà, V., Mannaioni, G., Moroni, F., Tono, N., Angeli, P., Gatta, A. and Amodio, P. (2011), Different biochemical correlates for different neuropsychiatric abnormalities in patients with cirrhosis. Hepatology, 53: 558–566. doi: 10.1002/hep.24043
Potential conflict of interest: Nothing to report.
This article first published online on January 3, 2011; the abstract has since been updated. The correct version appears in print.
- Issue published online: 27 JAN 2011
- Article first published online: 3 JAN 2011
- Accepted manuscript online: 18 OCT 2010 11:16AM EST
- Manuscript Accepted: 28 SEP 2010
- Manuscript Received: 8 APR 2010
The diagnosis of hepatic encephalopathy (HE) relies on clinical, neurophysiological, psychometric and laboratory variables. The relationships between such tests remain debated. The aim of this study was to determine the laboratory correlates/prognostic value of neurophysiological/psychometric abnormalities in patients with cirrhosis. Seventy-two patients and 14 healthy volunteers underwent EEG and paper-and-pencil psychometry (PHES). Blood was obtained for C reactive protein (CRP), interleukin 6 (IL6), tumor necrosis factor (TNF)α, ammonia and indole/oxindole. Patients were followed prospectively for a median of 22 months in relation to the occurrence of death, transplantation and HE-related hospitalizations. Thirty-three patients had normal PHES and EEG, 6 had abnormal PHES, 18 abnormal EEG and 13 abnormal PHES and EEG. Patients with abnormal PHES had higher CRP (17 ± 22 vs 7 ± 6, P < 0.01), IL6 (32 ± 54 vs 12 ± 13, P < 0.05) and TNFα (17 ± 8 vs 11 ± 7, P < 0.001) levels than those with normal PHES. Patients with abnormal EEG had higher indole (430 ± 270 vs 258 ± 255, P < 0.01) and ammonia (66 ± 35 vs 45 ± 27, P < 0.05) levels than those with normal EEG. Psychometric test scores showed significant correlations with CRP, TNFα and IL6; EEG indices with ammonia and IL6. CRP and TNFα concentrations were independent predictors of abnormal PHES, ammonia and indole of abnormal EEG on multivariate analysis. Seven patients were lost to follow-up; of the remaining 65, 20 died and 14 underwent transplantation; 15 developed HE requiring hospitalization. PHES and EEG performance were independent predictors of HE and death (P < 0.05). Conclusion: PHES and EEG abnormalities in patients with cirrhosis have partially different biochemical correlates and independently predict outcome. (HEPATOLOGY 2011;53:558-566)