S1212 Nutritional Deficiencies in Decompensated Cirrhotics with Hepatic Encephalopathy

Abstract

Introduction: Hepatic encephalopathy (HE) is a major complication of end-stage cirrhosis. Predisposing factors include infection, electrolyte imbalances, constipation, and GI bleeding. HE has also been associated with nutritional deficiencies which might be secondary to inadequate diet, such as protein deficiency, gut malabsorption, and decreased hepatic storage. In particular, zinc deficiency hinders the metabolism of ammonia, thus causing buildup and contributing to worsening of HE.1 We aimed to assess the frequency in which vitamins and zinc were tested in our decompensated cirrhotic population with HE. Methods: We performed a retrospective review of 145 patients with decompensated cirrhosis that were seen in an outpatient hepatology clinic from January 2020 to May 2021. Patient demographics, decompensations and management were recorded. Nutrients that were evaluated included zinc, vitamin B12, and thiamine. Results: Out of 145 patients, 73 were found to have HE. 33/73 were male, and the average MELD score was 15.5 ± 6.3. 32 patients had NASH cirrhosis, 22 had alcoholic cirrhosis, 9 had hepatitis B, C or both and 9 had other diagnoses. For the management of HE, 27 patients were on lactulose, 35 on lactulose and rifaximin, 8 on only rifaximin and 3 on other regimens. Intrahepatic portosystemic shunt (TIPS) placement was found in 8 patients. Average albumin level was 3.35 ± 0.6 g/dL. Amongst patients with HE, 17/23 (74%) were deficient in zinc (< 60 mcg/dL) . Thiamine deficiency was found in 75% of the patients, with 11/32 (34%) low (8-30 nMol/L), and 13/32 (41%) severely low in Thiamine (< 8 nMol/L). B12 deficiency (< 300 pg/mL) was found in 2/47 (4%) patients. Conclusion: Deficiency in certain vitamins and zinc can worsen symptoms associated with HE in patients with cirrhosis. Our study demonstrated that zinc, vitamin B12, and thiamine levels are commonly low in these patients, and that providers should evaluate and optimize patients with HE from a nutritional perspective. Further studies are needed to determine if routine testing and treatment for these elements have a positive impact on the clinical trajectory of HE.