Muscle depletion increases the risk of overt and minimal hepatic encephalopathy: results of a prospective study

Abstract

Muscle depletion is frequently encountered in cirrhotic patients. As muscle may represents an alternative site of ammonia detoxification in liver diseases, our study was aimed at investigating whether a decrease in muscle mass or function may independently influence the prevalence of neurocognitive alterations in cirrhosis. Three-hundred consecutive hospitalized cirrhotic patients were prospectively enrolled. Liver function, a complete neurocognitive assessment for the diagnosis of clinical or subclinical hepatic encephalopathy (HE) and parameters of nutritional status and muscle function were evaluated in each patient at admission. Clinically overt HE, at admission or in the last 12 months, or a diagnosis of minimal HE were significantly higher in cirrhotic patients with muscle depletion or decreased muscle strength. The fasting venous blood ammonia concentrations were also higher in this group. Muscle depletion was an independent risk factor at multivariate analysis both for overt and minimal HE. In conclusion cirrhotic patients with muscle depletion are at higher risk of HE and the amelioration of nutritional status is a possible goal to decrease the prevalence of neurocognitive alterations in these patients.

Minimal Hepatic Encephalopathy: The Reality Beyond Our Eyes

“…59 Some subgroups of patients would benefit the most from testing for MHE as quite specific recommendations can be made if it is diagnosed. 3 Active drivers should be advised that they have diminished driving abilities and an increased probability of road traffic accidents; active workers ought to have their risk at work evaluated and counselling regarding handling complex/dangerous machinery should be provided; patients with cognitive impairment and decline in work performance perceived by themselves, relatives or by colleagues should be assessed and, if possible, changes in daily/working activities should be carried out.…”

Nutrition in the Management of Cirrhosis and its Neurological Complications

“…83 For example, a recent prospective study demonstrated that cirrhotic patients with muscle depletion are at higher risk of HE and that the amelioration of nutritional status is an effective goal to decrease the prevalence of cognitive impairment in these patients. 84 As mentioned above, cirrhosis is often associated with thiamine (vitamin B 1 ) deficiency leading to increased prevalence of Wernicke's encephalopathy, a finding that has been attributed to loss of liver stores of thiamine. 85 In addition, cirrhosis is characterized by an imbalance in plasma levels of aromatic amino acids (AAAs) and branched-chain amino acids (BCAAs) and it has been suggested that altered plasma and brain BCAA/AAA ratios are implicated in the pathogenesis of HE in cirrhosis.…”

Diagnosis and Treatment of Low-Grade Hepatic Encephalopathy

“…Similarly, poor nutritional status is common among cirrhotic patients, especially in advanced disease, and can be a compounding factor in the development of HE. In particular, the loss of skeletal muscle mass can lead to HE as skeletal muscle is involved in the metabolism of ammonia (table 2) [23]. …”