Abstract
Currently, the Japanese society of clinical nutrition (JSCN) defines serum zinc (Zn) level < 60 μg/dL as Zn deficiency and 60 μg/dL ≤ serum Zn level < 80 μg/dL as subclinical Zn deficiency, and 80 μg/dL ≤ serum Zn level < 130 μg/dL as normal Zn range. We aimed to elucidate the prognostic impact of this Zn classification system in patients with liver cirrhosis (LC) compared to the Child–Pugh classification and the albumin–bilirubin (ALBI) grading system (n = 441, median age = 66 years). The Akaike information criterion (AIC) with each evaluation method was tested in order to compare the overall survival (OS). The median serum Zn level was 65 μg/dL. There were 56 patients with normal Zn level, 227 with subclinical Zn deficiency and 158 with Zn deficiency. OS was well stratified among three groups of serum Zn level (p < 0.0001). The AIC value for survival by the Zn classification system was the lowest among three prognostic models (AIC: 518.99 in the Child–Pugh classification, 502.411 in ALBI grade and 482.762 in the Zn classification system). Multivariate analyses of factors associated with OS revealed that serum Zn classification by JSCN was an independent factor. In conclusion, the serum Zn classification proposed by JSCN appears to be helpful for estimating prognosis in LC patients.
Highlights
Liver cirrhosis (LC) is a terminal form of chronic liver damage. It is often accompanied by several clinical manifestations including hepatic encephalopathy (HE), ascites, varices caused by portal hypertension or liver carcinogenesis, with all of them leading to dismal prognosis [1,2,3,4]
In cases with hypozincemia, we considered Zn supplementation therapy such as polaprezinc or Zn acetate hydrate according to the recommendations of the manufacturer
We retrospectively investigated the relationship between serum Zn level and baseline data, and the impact of serum Zn classification on survival compared with the C–P classification or the ALBI grading system
Summary
Liver cirrhosis (LC) is a terminal form of chronic liver damage It is often accompanied by several clinical manifestations including hepatic encephalopathy (HE), ascites, varices caused by portal hypertension or liver carcinogenesis, with all of them leading to dismal prognosis [1,2,3,4]. The major limitation of this system is that it includes several subjective components (hepatic encephalopathy and ascites) and interrelated components (serum albumin and ascites) [5]. To overcome these obstacles, a simple grading system for the evaluation of hepatic function, called the albumin–bilirubin (ALBI) grade, which is calculated by only two serum markers (i.e., serum albumin level and total bilirubin level), has been recently reported [6]. The modified ALBI grade using an additional cut-off value for the ALBI score has been reported as a useful predictor for patients with HCC [15]
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