title: Different biochemical correlates for different neuropsychiatric abnormalities in patients with cirrhosis.
abstract: The diagnosis of hepatic encephalopathy (HE) relies on clinical, neurophysiological, psychometric and laboratory variables. The relationships between such tests remain debated. The aim of this study was to determine the laboratory correlates/prognostic value of neurophysiological/psychometric abnormalities in patients with cirrhosis. Seventy-two patients and 14 healthy volunteers underwent EEG and paper-and-pencil psychometry (PHES). Blood was obtained for C reactive protein (CRP), interleukin 6 (IL6), tumor necrosis factor (TNF)α, ammonia and indole/oxindole. Patients were followed prospectively for a median of 22 months in relation to the occurrence of death, transplantation and HE-related hospitalizations. Thirty-three patients had normal PHES and EEG, 6 had abnormal PHES, 18 abnormal EEG and 13 abnormal PHES and EEG. Patients with abnormal PHES had higher CRP (17 ± 22 vs 7 ± 6, P < 0.01), IL6 (32 ± 54 vs 12 ± 13, P < 0.05) and TNFα (17 ± 8 vs 11 ± 7, P < 0.001) levels than those with normal PHES. Patients with abnormal EEG had higher indole (430 ± 270 vs 258 ± 255, P < 0.01) and ammonia (66 ± 35 vs 45 ± 27, P < 0.05) levels than those with normal EEG. Psychometric test scores showed significant correlations with CRP, TNFα and IL6; EEG indices with ammonia and IL6. CRP and TNFα concentrations were independent predictors of abnormal PHES, ammonia and indole of abnormal EEG on multivariate analysis. Seven patients were lost to follow-up; of the remaining 65, 20 died and 14 underwent transplantation; 15 developed HE requiring hospitalization. PHES and EEG performance were independent predictors of HE and death (P < 0.05).
  
  
  CONCLUSIONS
  PHES and EEG abnormalities in patients with cirrhosis have partially different biochemical correlates and independently predict outcome.
authors.affiliation: Department of Clinical and Experimental Medicine, University of Padua, Padua, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Montagnese
authors.forename: Anna
authors.initials: A
authors.lastname: Biancardi
authors.forename: Sami
authors.initials: S
authors.lastname: Schiff
authors.forename: Paolo
authors.initials: P
authors.lastname: Carraro
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Carlà
authors.forename: Guido
authors.initials: G
authors.lastname: Mannaioni
authors.forename: Flavio
authors.initials: F
authors.lastname: Moroni
authors.forename: Natascia
authors.initials: N
authors.lastname: Tono
authors.forename: Paolo
authors.initials: P
authors.lastname: Angeli
authors.forename: Angelo
authors.initials: A
authors.lastname: Gatta
authors.forename: Piero
authors.initials: P
authors.lastname: Amodio
mesh_terms: D000328:Adult; D000368:Aged; D000641:Ammonia / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D016022:Case-Control Studies; D004569:Electroencephalography; D005260:Female; D005500:Follow-Up Studies; D006501:Hepatic Encephalopathy / Q000097:blood* / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D007211:Indoles / Q000097:blood; D015850:Interleukin-6 / Q000097:blood*; D008103:Liver Cirrhosis / Q000097:blood* / Q000150:complications*; D008297:Male; D008875:Middle Aged; D000078183:Oxindoles; D011237:Predictive Value of Tests; D011594:Psychometrics; D012307:Risk Factors; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*
chemical_list: D015415:Biomarkers; D007211:Indoles; D015850:Interleukin-6; D000078183:Oxindoles; D014409:Tumor Necrosis Factor-alpha; C022960:2-oxindole; D000641:Ammonia; D002097:C-Reactive Protein