Association between serum albumin and cognitive dysfunction in hepatic encephalopathy: An exploratory data analysis

Area of Science:

• Hepatology
• Neurology
• Clinical Biochemistry

Background:

• Covert hepatic encephalopathy (CHE) significantly impacts cirrhotic patients' prognosis.
• Early diagnosis of hepatic encephalopathy (HE) is crucial for patient quality of life and preventing overt HE.
• Identifying predictive clinical parameters for early-stage HE is essential.

Purpose of the Study:

• To identify a clinical parameter for predicting cognitive dysfunction in cirrhotic patients with early-stage HE.
• To establish a screening method for early detection of cognitive impairment in at-risk cirrhotic populations.

Main Methods:

• Utilized data from 172 cirrhotic patients in rifaximin trials.
• Employed Classification and Regression Trees (CART) to identify clinical profiles associated with cognitive dysfunction.
• Assessed cognitive function via the Number Connection Test (NCT-B) time prolongation.

Main Results:

• CART analysis identified age (≤65 years) and serum albumin level as key predictors.
• In cirrhotic patients ≤65 years without PSS, a serum albumin cutoff of 3.05 g/dL predicted NCT-B prolongation (AUC=0.80).
• Serum albumin outperformed other biomarkers like ammonia and PT-INR in predicting cognitive impairment.

Conclusions:

• Lower serum albumin levels serve as a potential clinical biomarker for impaired cognitive function in early-stage HE.
• Serum albumin can be utilized as a screening tool for cirrhotic patients (≤65 years, no PSS) prior to neuropsychological testing.
• This approach aids in the early detection and management of cognitive deficits in hepatic encephalopathy.