Association between serum albumin and cognitive dysfunction in hepatic encephalopathy: An exploratory data analysis

Abstract

Background and AimBecause covert hepatic encephalopathy (CHE) has been shown to affect the prognosis of cirrhotic patients, early diagnosis of hepatic encephalopathy (HE) is a prerequisite for the preservation of patients' quality of life and for prophylaxis of overt HE. The aim of this study was to identify a clinical parameter to predict impairment of cognitive function in cirrhotic patients with early‐stage HE.MethodsWe investigated the data from 172 patients with cirrhotic or idiopathic portosystemic shunt (PSS) in phase II/III trials of rifaximin in Japan. Classification and regression trees (CARTs) were constructed to identify clinical profiles related to cognitive dysfunction as indicated by the prolongation of time required for the Number Connection Test (NCT‐B).ResultsCART analysis detected age 65 years as the variable for the initial split, and serum albumin level was selected as the variable for the second split among patients aged ≤65 years. In 27 cirrhotic patients aged ≤65 years without PSS, receiver operating characteristic curve analysis revealed that the optimal albumin level cutoff point was 3.05 g/dL, and the area under the curve was 0.80 for the prolongation of NCT‐B time, which was higher than that of the branched‐chain amino acids‐to‐tyrosine ratio (0.46), the prothrombin time–international normalized ratio (PT‐INR) (0.68), serum ammonia (0.61), and total bilirubin (0.69).ConclusionsLower serum albumin level as a clinical biomarker associated with impaired cognitive function may be available as a screening examination for early‐stage HE in cirrhotic patients aged ≤65 years without PSS before undergoing neuropsychological tests.

A simple covert hepatic encephalopathy screening model based on blood biochemical parameters in patients with cirrhosis

“…These results, which suggest the usefulness of the easy-to-use scoring model consisting of only blood biochemical parameters for CHE screening, have meaningful clinical implications for the management of patients with cirrhosis. These results also corroborate those of previous studies that reported an association between CHE and albumin or ammonia levels [ 16 , 25 , 28 – 30 ].…”

Hepatic and cardiac implications of increased toxic amyloid-beta serum level in lipopolysaccharide-induced neuroinflammation in rats: new insights into alleviating therapeutic interventions

“…According to our observed results, decreased albumin level in LPS-induced group was followed by increased ammonia, ALP, AST, and ALT level when compared with the control group (I). In accordance with our results, decreased serum albumin as a drawback of neuroinflammatory AD-type progression may results in server liver dysfunctions due to systemic malnutrition inflammatory syndrome (Kaji et al 2021 ; Llewellyn et al 2010a ; Cattin et al 1997a ). Meanwhile, increased Aβ serum level associated with increased cholesterol, triglycerides, and inflammatory cytokines serum levels in addition to decreased albumin level directly resulted in cardiac dysfunction illustrated in the form of increased heart rate, troponin I, CK-MB, LDH, ALT, and AST serum levels as illustrated in Fig.…”

Comparative Effectiveness of Different Treatment Regimens with Rifaximin-α in Patients with Minimal Hepatic Encephalopathy and Liver Cirrhosis (Analysis of 6-Month Follow-Up)

“…При МПЭ отсутствуют явные клинические проявления, поэтому ее можно диагностировать только с помощью нейропсихологических или психометрических тестов [4]. МПЭ также может проявляться как недавние падения (40% в течение предыдущего года для тех, у кого диагностирована МПЭ, по сравнению с 12,9% для лиц без МПЭ), а также нарушением качества сна [5,6]. Помимо этого, наличие МПЭ у пациентов с ЦП имеет более высокий однолетний риск автомобильных аварий (17% из 97 пациентов с МПЭ против 3% из 70 лиц без МПЭ) [7].…”