A clinical research on the risk factors and the development of diagnostic model for hepatic encephalopathy

Abstract

Abstract: Objective To identify laboratory diagnostic markers of hepatic encephalopathy (HE), we developed a diagnostic model of HE and investigated the diagnostic value of serum homocysteine, lactate, procalcitonin, and bile acid levels in HE. Methods A total of 371 patients with liver cirrhosis admitted to the First Affiliated Hospital of Harbin Medical University from August 2020 to August 2022 were analyzed using Spearman’s correlation coefficient, univariate and multivariate analysis to identify factors affecting the occurrence of HE, and to establish a diagnostic model. Results Procalcitonin (378.2 ± 71.5 pg/mL), bile acid ( 41.6 ± 9.5 μmol/L) in patients with HE was higher than those (Procalcitonin 47.3 ± 8.1 pg/mL, bile acid 9.7 ± 0.8 μmol/L) in non HE (P<0.05), lactic acid (0.29 ± 0.11 mmol/L), serum homocysteine (2.8 ± 1.1 μmol/L) in patients with HE was lower than those (lactic acid 0.94 ± 0.17 pg/mL, serum homocysteine 10.2 ± 2.3 μmol/L) in patients with non HE (P<0.05). Spearman correlation analysis showed that the correlation coefficients between lactate, procalcitonin, bile acids, serum homocysteine and HE were -0.15, 0.41, 0.29 and -0.19, respectively. Univariate logistic regression analysis showed that the risk of developing HE increased with higher bile acid levels (P=0.004) and higher serum homocysteine levels (P=0.058). The multivariate logistic regression diagnostic model of bile acid levels and serum homocysteine showed that the area under the ROC curve (AUC) was 0.720, indicating that the diagnostic model achieved satisfactory evaluation effect. The model formula was the logistic regression equation P=-2.4544 + 0.0117 * (bile acid level) + 0.0198 * (serum homocysteine). Conclusion In this study, logistic regression analysis was used to establish a diagnostic model of HE, which is beneficial for the early differential diagnosis of patients. Especially the combined detection of serum homocysteine and bile acid levels was considered more meaningful.

Key words: Hepatic encephalopathy, Serum homocysteine, Lactate, Procalcitonin and bile acids

DENG Wen-jia, WANG Lei, WANG Hao-ran, ZHAO Ge. A clinical research on the risk factors and the development of diagnostic model for hepatic encephalopathy[J]. Chinese Hepatolgy, 2024, 29(9): 1085-1090.

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