Amit Agarwal1, Shilpa Avarebeel2, Narendra S Choudhary3, Mohan Goudar4, C J Tejaswini5. 1. Junior Resident, Department of Medicine, JSS Medical College, Mysuru, Karnataka, India. 2. Senior Resident, Department of Medicine, JSS Medical College, Mysuru, Karnataka, India. 3. Consultant, Department of Hepatology, Medanta Institute of Digestive and Hepatobiliary Sciences, Gurgaon, Haryana, India. 4. Professor, Department of Medicine, JSS Medical College, Mysuru, Karnataka, India. 5. Assistant Professor, Department of Medicine, JSS Medical College, Mysuru, Karnataka, India.
Abstract
INTRODUCTION: Zinc, copper, manganese and magnesium are essential trace elements whose role in chronic liver disease and its complications is not clear. AIM: To study the concentration of these elements in patients with Chronic Liver Disease (CLD) with respect to Child-Torcotte-Pugh (CTP) scoring. MATERIALS AND METHODS: This was an observational study carried out in the Department of Medicine, JSS Hospital, Mysore, India, between October 2013 and October 2015. A total of 75 patients with cirrhosis were prospectively enrolled. Severity of liver disease was assessed based on CTP score and patients were grouped into Class A, B and C. Routine investigations were done and following trace elements were assessed in all-zinc, copper, manganese and magnesium. RESULTS: The serum concentrations of zinc decreased with severity of liver disease, and the mean difference between different severity classes was statistically significant (p<0.001). There was a significant negative correlation between zinc and CTP Score (r= -0.439; p<0.001). Copper concentration was increased in patients with more severe cirrhosis and mean level difference of copper among the CTP groups were statistically significant (p<0.001). Moreover, copper showed significant positive correlation with CTP Score (r=0.385; p<0.001). The serum levels of manganese were significantly higher in patients with CTP C class in comparison to patients with CTP A and B class (p<0.05); Manganese showed significant positive correlation with CTP Score (r=0.271; p= 0.019). The concentrations of magnesium did not differ significantly between CTP class with the mean level difference not statistically significant. CONCLUSION: Increasing liver dysfunction alters the metabolism of trace elements towards excess of copper and deficiency of zinc.
INTRODUCTION: Zinc, copper, manganese and magnesium are essential trace elements whose role in chronic liver disease and its complications is not clear. AIM: To study the concentration of these elements in patients with Chronic Liver Disease (CLD) with respect to Child-Torcotte-Pugh (CTP) scoring. MATERIALS AND METHODS: This was an observational study carried out in the Department of Medicine, JSS Hospital, Mysore, India, between October 2013 and October 2015. A total of 75 patients with cirrhosis were prospectively enrolled. Severity of liver disease was assessed based on CTP score and patients were grouped into Class A, B and C. Routine investigations were done and following trace elements were assessed in all-zinc, copper, manganese and magnesium. RESULTS: The serum concentrations of zinc decreased with severity of liver disease, and the mean difference between different severity classes was statistically significant (p<0.001). There was a significant negative correlation between zinc and CTP Score (r= -0.439; p<0.001). Copper concentration was increased in patients with more severe cirrhosis and mean level difference of copper among the CTP groups were statistically significant (p<0.001). Moreover, copper showed significant positive correlation with CTP Score (r=0.385; p<0.001). The serum levels of manganese were significantly higher in patients with CTP C class in comparison to patients with CTP A and B class (p<0.05); Manganese showed significant positive correlation with CTP Score (r=0.271; p= 0.019). The concentrations of magnesium did not differ significantly between CTP class with the mean level difference not statistically significant. CONCLUSION: Increasing liver dysfunction alters the metabolism of trace elements towards excess of copper and deficiency of zinc.
Authors: Lei Yu; Iris W Liou; Scott W Biggins; Matthew Yeh; Florencia Jalikis; Lingtak-Neander Chan; Jason Burkhead Journal: Hepatol Commun Date: 2019-06-26