Endozepine-4 levels are increased in hepatic coma.
OBJECTIVE
To evaluate the serum levels of endozepine-4, their relation with ammonia serum levels, the grading of coma and the severity of cirrhosis, in patients with hepatic coma.


METHODS
In this study we included 20 subjects with Hepatic coma, 20 subjects with minimal hepatic encephalopathy (MHE) and 20 subjects control. All subjects underwent blood analysis, Child Pugh and Model for End - stage liver disease (MELD) assessment, endozepine-4 analysis.


RESULTS
Subjects with hepatic coma showed significant difference in endozepine-4 (P < 0.001) and NH3 levels (P < 0.001) compared both to MHE and controls patients. Between NH3 and endozepine-4 we observed a significant correlation (P = 0.009; Pearson correlation 0.570). There was a significant correlation between endozepine-4 and MELD (P = 0.017; Pearson correlation = 0.529). In our study blood ammonia concentration was noted to be raised in patients with hepatic coma, with the highest ammonia levels being found in those who were comatose. We also found a high correlation between endozepine-4 and ammonia (P < 0.001). In patients with grade IV hepatic coma, endozepine levels were significantly higher compared to other groups.


CONCLUSIONS
This study suggests that an increased level of endozepine in subjects with higher levels of MELD was observed. In conclusion, data concerning involvement of the GABA-ergic system in HE coma could be explained by stage-specific alterations.
Giulia Malaguarnera, Marco Vacante, Maria Giordano, Michele Malaguarnera, Research Center "The Great Senescence" Hospital of Cannizzaro, University of Catania, via Messina 829, 95100 Acicastello, Italy.
Giulia
G
Malaguarnera
Giulia Malaguarnera, Marco Vacante, Maria Giordano, Michele Malaguarnera, Research Center "The Great Senescence" Hospital of Cannizzaro, University of Catania, via Messina 829, 95100 Acicastello, Italy.
Marco
M
Vacante
Giulia Malaguarnera, Marco Vacante, Maria Giordano, Michele Malaguarnera, Research Center "The Great Senescence" Hospital of Cannizzaro, University of Catania, via Messina 829, 95100 Acicastello, Italy.
Filippo
F
Drago
Giulia Malaguarnera, Marco Vacante, Maria Giordano, Michele Malaguarnera, Research Center "The Great Senescence" Hospital of Cannizzaro, University of Catania, via Messina 829, 95100 Acicastello, Italy.
Gaetano
G
Bertino
Giulia Malaguarnera, Marco Vacante, Maria Giordano, Michele Malaguarnera, Research Center "The Great Senescence" Hospital of Cannizzaro, University of Catania, via Messina 829, 95100 Acicastello, Italy.
Massimo
M
Motta
Giulia Malaguarnera, Marco Vacante, Maria Giordano, Michele Malaguarnera, Research Center "The Great Senescence" Hospital of Cannizzaro, University of Catania, via Messina 829, 95100 Acicastello, Italy.
Maria
M
Giordano
Giulia Malaguarnera, Marco Vacante, Maria Giordano, Michele Malaguarnera, Research Center "The Great Senescence" Hospital of Cannizzaro, University of Catania, via Messina 829, 95100 Acicastello, Italy.
Michele
M
Malaguarnera
D000328:Adult; D000368:Aged; D000641:Ammonia / Q000097:blood; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D026261:Diazepam Binding Inhibitor / Q000097:blood*; D005260:Female; D006501:Hepatic Encephalopathy / Q000097:blood* / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D015854:Up-Regulation
D015415:Biomarkers; D026261:Diazepam Binding Inhibitor; D000641:Ammonia
Cirrhosis, Benzodiazepine; Endozepine-4; Glutamate-related neurotoxicity which in turn may alter the γ-aminobutyric acid; Hepatic coma; Hepatic encephalopathy; Model for End - stage liver disease; Peripheral benzodiazepine receptor