Nutritional status in non-alcoholic subclinical porto-systemic encephalopathy

AIM: To understand the role of nutritional status in cirrhotic patients without clinical porto-systemic encephalopathy (PSE).

METHODS: Fifty-one non-alcoholic patients with cirrhosis without PSE were studied prospectively and compared with 20 healthy volunteers. The nutritional evaluation included serum prealbumin, albumin, transferrin, body mass index ( BMI ), mid-arm muscle circumference (MAMC), and grip power. The occurrence of subclinical PSE ( SPSE ) was defined when N20-N65 inter-peak latencies of median nerve-stimulated somatosensory evoked potentials were > 2.5 standard deviations of control means. Blood chemistries were tested within 12 h of somatosensory evoked potentials test and nutritional evaluation.

RESULTS: Twenty-five, 17 and 9 cirrhotic patients were graded as Child-Pugh class A, B, and C, respectively. Twenty-four (47.1%) patients developed SPSE. Cirrhotic patients with SPSE had lower serum albumin (2.8 mg/L ± 5 mg/L vs 31 mg/L ± 7 mg/L, P < 0.001) levels than those without SPSE. Prealbumin (106mg/L ± 57mg/L vs 125 mg/L ± 58 mg/L), transferrin (1.64 g/L ± 0.46 g/L vs 1.78 g/L ± 0.58 g/L), BMI (23.7 kg/m²± 2.7 kg/m²vs 25.3 kg/m²± 3.6 kg/m²), MAMC (22.2 cm ± 2.6 cm vs 22.7 cm ±3.5 cm), and grip power (26.3 kg ± 6.4 kg vs 26.9 kg ± 6.8 kg) were not different between cirrhotic patients with and without SPSE. N20-N65 inter-peak latencies were correlated with serum albumin levels (P = 0.01) but not with prealbumin, transferrin, BMI, MAMC, or grip power. Serum albumin, prealbumin and transferrin levels were different among cirrhotic patients with Child-Pugh classes A, B, and C (P < 0.05). BMI, MAMC, and grip power were not different among Child-Pugh classes A, B and C.

CONCLUSION: Our data suggest that serum albumin level is a simple test in the evaluation of nutritional status in patients with cirrhosis.