Goals: Comparison of nitric oxide (NO) levels in cirrhotic patients with
and without hepatic encephalopathy (HE), evaluation of possible
correlation between HE and other clinical or laboratory characteristics,
and estimation of utilization of NO levels in clinical practice.
Background: HE is a neuropsychiatric complication of cirrhosis. The
exact pathogenetic mechanisms underlying the presence of HE are not
known. However, dysfunction of the NO pathway and ammonia detoxification
are thought to play a major role.
Study: Sixty-seven cirrhotic patients, 36 (53.7%) without HE, and 31
(46.3%) with HE were included in the study. Eighteen healthy
individuals were used as control group. Clinical and laboratory data,
including ammonia and stable end products of NO using Griess reaction,
were collected.
Results: NOx levels were statistically significantly higher in cirrhotic
patients (225.5 mu mol/L) than in control group [(67.94 mu mol/L) (P =
0.000)]. NOx levels were, also, statistically significantly higher in
patients with HE compared with patients without HE (324.67 mu mol/L vs.
141.96 mu mol/L, P = 0.000). Significant correlation between the
presence of HE and NOx, ammonia, C-reactive protein, albumin, Model for
End-Stage Liver Disease score, and Child-Pugh classification revealed.
NOx levels also correlated with severity of HE. NOx and ammonia are
independent factors predicting HE according to regression analysis.
Diagnostic accuracy for the diagnosis of HE using a combination of NOx
and ammonia was superior compared with standalone NOx or ammonia
utilization.
Conclusions: NOx levels are correlated with the presence and severity of
HE. NOx levels determination, in addition to ammonia levels, could
contribute in diagnosis of HE
