标题：Predictive biomarkers for diagnosis of minimal hepatic encephalopathy in patients with liver cirrhosis: A preliminary result in a single center study in Japan
摘要：Aim: Minimal hepatic encephalopathy (MHE) in liver cirrhosis (LC) is a subclinical abnormality which is only detectable by neuropsychiatric and neurophysiological tests. Reliable predictive biomarkers for diagnosing MHE have not been confirmed. This study examined potential biomarkers to detect MHE in LC patients. Methods: We divided 35 outpatients with LC into two groups based on the presence of MHE according to the results of computer-aided neuropsychiatric testing using four psychometric tests. Differences in clinical and laboratory data were compared between the two groups, and predictive biomarkers for diagnosing MHE were determined using the logistic regression model. Results: The prevalence of MHE in LC was 28.6% (10/35). Clinical features involving Child-Pugh classification and the modified end-stage liver disease score showed no differences between the MHE-positive and MHE-negative patients. Among biochemical parameters, elevated plasma ammonia level (P=0.034), increased creatinine (P=0.008), and low estimated glomerular filtration rate (P=0.042) showed greater significance in MHE-positive patients compared with MHE-negative patients. However, univariate and multivariate analysis showed that ammonia level (odds ratio, 1.023 and 1.031, respectively; 95% confidence interval of coefficient estimate, 1.005-1.041 and 1.006-1.058, respectively) was the only significant independent predictor for the detection of MHE. Conclusion: Plasma ammonia level may be useful as a predictive biomarker to prediagnose the neuropsychiatric test-based diagnosis of MHE. Our results also reinforce previous findings on crucial roles for renal ammonia metabolism and urinary excretion in patients with LC.
