IL-6 and IL-18 in blood may discriminate cirrhotic patients with and without minimal hepatic encephalopathy.
OBJECTIVE
Patients with liver cirrhosis may present minimal hepatic encephalopathy (MHE) that can be unveiled using specific neuropsychologic examination. Evaluation of MHE in cirrhotic patients might have prognostic value. The psychometric HE score (PHES) has been recommended as the "gold standard" in the diagnosis of MHE. It has been proposed that critical flicker frequency (CFF) analysis would be useful for easier detection of MHE. It would also be useful to have some peripheral parameter that could reflect the presence of MHE. It has been recently proposed that inflammation-associated alterations and hyperammonemia may cooperate in the induction of hepatic encephalopathy. The aim of the present work was to assess whether there is a correlation between the alterations in parameters reflecting inflammation, hyperammonemia, and the presence of MHE.


METHODS
We have studied in 55 patients with liver cirrhosis and 26 controls the performance in the PHES battery and the CFF, ammonia, and some interleukins (ILs) as inflammatory markers.


RESULTS
IL-6 and IL-18 were significantly higher (2.5-fold and 2.2-fold, respectively) in patients with MHE than in those without MHE. There were significant correlations between IL-6 or IL-18 levels and PHES score and CFF. Moreover, all patients with MHE had IL-6 levels higher than 11 ng/mL, whereas all patients without MHE had IL-6 levels lower than 11 ng/mL.


CONCLUSIONS
Inflammatory alterations related with IL-6 and IL-18 may contribute to MHE. Serum concentration of IL-6 and IL-18 may be useful to discriminate cirrhotic patients with and without MHE.
Fundación Investigacion Hospital Clinico de Valencia, Valencia, Spain.
Carmina
C
Montoliu
Blanca
B
Piedrafita
Miguel A
MA
Serra
Juan A
JA
del Olmo
Amparo
A
Urios
Jose M
JM
Rodrigo
Vicente
V
Felipo
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D003937:Diagnosis, Differential; D005260:Female; D005425:Flicker Fusion; D006501:Hepatic Encephalopathy / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D022124:Hyperammonemia / Q000097:blood / Q000175:diagnosis; D020382:Interleukin-18 / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood*; D008103:Liver Cirrhosis / Q000097:blood* / Q000150:complications; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011379:Prognosis
D015415:Biomarkers; D020382:Interleukin-18; D015850:Interleukin-6