title: Association of serum zinc levels with liver function and survival in patients awaiting liver transplantation.
abstract: OBJECTIVE
  Zinc is an important trace element with catalytic and defensive functions. We assessed the impact of zinc deficiency in patients with end-stage liver disease awaiting liver transplantation.
  
  
  METHODS
  Serum zinc levels were measured at the time of evaluation for liver transplantation (n = 368). Patients were dichotomized in two groups based on low and normal zinc serum levels.
  
  
  RESULTS
  Serum zinc levels are tightly associated with liver function as patients with low zinc levels (n = 226) had a higher Model for End-Stage Liver Disease (MELD) score (15.0 [5.0-40.0]) than patients with normal zinc (n = 142) levels (9.0 [6.0-34.0]; p < 0.00). Multivariate analysis demonstrated that serum zinc levels function as an independent predictor of hepatic decompensation (hydropic decompensation: odds ratio [OR] 0.82; 95% confidence interval [CI] 0.70-0.96; p = 0.015; hepatic encephalopathy: OR 0.80; 95% CI 0.71-0.90; p = 0.000; spontaneous bacterial peritonitis: OR 0.85; 95% CI 0.72-1.00; p = 0.047; hepatorenal syndrome: OR 0.83; 95% CI 0.72-0.95; p = 0.011). Actuarial survival free of liver transplantation was reduced for low-zinc patients (26.7 ± 4.0 months; 95% CI 18.8-34.6) compared to patients with normal zinc levels (30.9 ± 3.0 months; 95% CI 24.9-36.9; p = 0.008). Reduction of zinc levels for patients on the transplantation list resulted in a 28.3-fold increased risk of death/liver transplantation (95% CI 3.2-244.8, p < 0.001).
  
  
  CONCLUSIONS
  Serum zinc levels are associated with reduced survival in end-stage liver disease patients. Whether or not zinc supplementation might be beneficial for patients on a liver transplantation list requires further study.
authors: Department of Internal Medicine IV, University Hospital of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
authors: Kilian
authors: K
authors: Friedrich
authors: Department of Internal Medicine IV, University Hospital of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
authors: Carina
authors: C
authors: Baumann
authors: Department of Internal Medicine I, University Hospital of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
authors: Maik
authors: M
authors: Brune
authors: Department of Internal Medicine IV, University Hospital of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
authors: Andreas
authors: A
authors: Wannhoff
authors: Department of Internal Medicine IV, University Hospital of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
authors: Christian
authors: C
authors: Rupp
authors: Department of Social Psychology, University of Mannheim, A5, 68131, Mannheim, Germany.
authors: Sabine G
authors: SG
authors: Scholl
authors: Department of Medicine II (Gastroenterology, Hepatology and Infectious Diseases), University Hospital of Heidelberg at Mannheim, Mannheim, 68167, Germany.
authors: Christoph
authors: C
authors: Antoni
authors: Department of Internal Medicine I, University of Ulm, Ulm, Baden-Wuerttemberg, Germany.
authors: Matthias
authors: M
authors: Dollinger
authors: Department of Medicine II, Freiburg University Medical Center, University of Freiburg, Freiburg, Germany.
authors: Christoph
authors: C
authors: Neumann-Haefelin
authors: Department of Internal Medicine IV, University Hospital of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
authors: Karl Heinz
authors: KH
authors: Weiss
authors: Department of Internal Medicine IV, University Hospital of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
authors: Wolfgang
authors: W
authors: Stremmel
authors: Department of Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
authors: Peter
authors: P
authors: Schemmer
authors: Department of Internal Medicine IV, University Hospital of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany. Daniel.Gotthardt@med.uni-heidelberg.de.
authors: Daniel Nils
authors: DN
authors: Gotthardt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002423:Cause of Death; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D017093:Liver Failure / Q000097:blood* / Q000401:mortality* / Q000601:surgery; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011300:Preoperative Care / Q000379:methods; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome; D014850:Waiting Lists; D055815:Young Adult; D015032:Zinc / Q000097:blood*
chemical_list: D015032:Zinc
keywords: Actuarial survival free of liver transplantation; End-stage liver disease; Liver transplantation; Serum zinc levels