title: Higher Grades and Repeated Recurrence of Hepatic Encephalopathy May Be Related to High Serum Manganese Levels.
abstract: Hepatic encephalopathy is a serious complication of liver failure. Until now, the precise pathophysiologic mechanisms are not fully determined. It has been demonstrated that manganese plays an important role in the pathogenesis of hepatic encephalopathy. Therefore, we studied manganese levels in serum of cirrhotic patients with hepatic encephalopathy in relation to grading and recurrence of hepatic encephalopathy. One hundred persons were enrolled in the study, 80 cirrhotic patients with or without encephalopathy and 20 healthy controls. Hepatic encephalopathy was diagnosed clinically and by laboratory findings. Serum manganese levels were measured in all participants. The grading of hepatic encephalopathy was significantly correlated to the severity of liver dysfunction. The mean serum manganese level was significantly higher in cirrhotic patients than in controls and in cirrhotic patients with encephalopathy than in those without encephalopathy. It was also significantly higher in patients with advanced grading of hepatic encephalopathy. Serum manganese level was positively correlated to number of recurrences of encephalopathy during a 6-month follow-up period. Serum manganese levels were able to predict recurrence of hepatic encephalopathy within 6 months following the episode. Serum manganese levels are positively correlated to the modified Child-Pugh score of cirrhosis as well as grading and number of recurrences of hepatic encephalopathy. Higher manganese levels seem to be related to worsening of the condition, and its measurement may be used as a predictor of repeated recurrences.
authors.affiliation: Tropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University , 1Algeish St., Tanta, Gharbiyah Governorate, 31111, Egypt. aakobtan@yahoo.com.
authors.forename: Abdelrahman A
authors.initials: AA
authors.lastname: Kobtan
authors.affiliation: Tropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University , 1Algeish St., Tanta, Gharbiyah Governorate, 31111, Egypt.
authors.forename: Ferial S
authors.initials: FS
authors.lastname: El-Kalla
authors.affiliation: Tropical Medicine and Infectious Diseases Department, Faculty of Medicine, Tanta University , 1Algeish St., Tanta, Gharbiyah Governorate, 31111, Egypt.
authors.forename: Hanan H
authors.initials: HH
authors.lastname: Soliman
authors.affiliation: Biochemistry Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
authors.forename: Soha S
authors.initials: SS
authors.lastname: Zakaria
authors.affiliation: Emergency Department, Senbelawein Central Hospital, Egyptian Ministry of Health, Senbelawein, Egypt.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Goda
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D006501:Hepatic Encephalopathy / Q000097:blood* / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood* / Q000150:complications / Q000453:epidemiology; D008297:Male; D008345:Manganese / Q000097:blood*; D008875:Middle Aged; D012008:Recurrence; D012720:Severity of Illness Index; D013054:Spectrophotometry, Atomic
chemical_list: D008345:Manganese
keywords: Hepatic encephalopathy; Hepatic encephalopathy grading; Hepatic encephalopathy recurrence; Manganese