ABSTRACT
Minimal hepatic encephalopathy [MHE] is a subtle complication of cirrhosis that may have a detrimental effect on daily functioning and may progress to overt hepatic encephalopathy [HE]. The aims of this study were to identify MHE and assess neuropsychological changes in those patients. A case-control study was conducted in 35 cirrhotic patients. MHE was identified by brain [hydrogen-1] magnetic resonance spectroscopy [1H-MRS]. Neuropsychological changes were evaluated using cognitive abilities screening instrument [CASI] test, Hamilton depression scale, and soft neurological sign assessment. Of the patients, 16 [45.7%] had significant brain 1H-MRS findings suggesting MHE in the form of decreased myo-Inositol/creatine [mI/Cr] and choline/creatine [Cho/Cr] ratios and increased glutamine-glutamate/creatine [Glx/Cr] ratios in white and grey matters compared to patients without MHE and healthy controls. Patients with MHE had significantly lower abstract thinking subset and total CASI score in comparison to patients without MHE [p = 0.03 and p = 0.05, respectively] and controls [p = 0.003 andp = 0.02, respectively]. No statistically significant differences were observed amongst different groups regarding other CASI subsets, depression, and soft neurological assessment in spite of a tendency towards increased values in patients with MHE. MHE associated with neurophysiological changes demonstrated by 1H-MRS preceded neuropsychological changes. Thus, 1H-MRS may be considered as a potential tool for diagnosis of cirrhosis-associated cerebral dysfunction and a promising method for prioritisation of subjects awaiting liver transplantation
ABSTRACT
Background and Aim: Natriuretic peptide [NP] system has emerged as one of the most important hormonal systems in control of cardiovascular homeostasis. Liver cirrhosis may affect NP levels that ere well described in heart failure. NP prognostic evaluation was well established in many diseases. Our aims were to measure serum and ascitic NT-proBNP levels in cirrhotic and cardiac Egyptian patients to diagnose a cut-off value for exclusion of heart failure, to assess if cirrhosis per se may contribute in NT-proBNP elevation and to assess the contribution of these levels as predictors of mortality in liver cirrhosis
Patients and Methods: A prospective cohort study was conducted in 80 patients [50 cirrhotics and 30 had heart failure]. Serum and ascitic [if available] NT-proBNP were measured. Cirrhotic patients were followed for 1-year. Kaplan-Meier survival analysis was used to evaluate 1-year survival rates. Logistic regression analyses were performed with 1-year mortality as the dependent variable
Results: Median serum and ascitic NT-proBNP levels in cirrhotics were 239.4 and 267 pg/ml versus 10596.6 and 9771 pg/ml in heart failure patients [P<0.001]. Serum and ascitic NT-proBNP cut-off values >1000 pg/ml resulted in sensitivity of 100% and 93.3% and specificity of 97.8% and 92.5% for exclusion of cardiac disease in cirrhotics. NT-proBNP was elevated in cirrhotics compared with age matched controls [P<0.001] and significantly correlated with severity of liver cirrhosis based on Child-Pugh and MELD [P=0.05, P<0.001 respectively]. Higher NT-proBNP associated with increased 1-year mortality. NT-proBNP was an independent predictor for mortality in cirrhotics in addition to other conventional factors
Conclusion: NT-pro BNP could be a powerful initial non-invasive diagnostic tool for exclusion of heart disease in cirrhotic patients. End stage cirrhosis per se may contribute to NT-proBNP elevation. NT-proBNP provided incremental information in 1-year mortality prediction in decompensated cirrhotics