Zinc deficiency predicts overt hepatic encephalopathy and mortality in liver cirrhosis patients with minimal hepatic encephalopathy

<jats:title>Abstract</jats:title><jats:sec><jats:title>Aim</jats:title><jats:p>Minimal hepatic encephalopathy (MHE) is associated with poor outcomes and the development of overt hepatic encephalopathy (OHE) in patients with liver cirrhosis (LC). Zinc plays a key role in the detoxification of ammonia, a risk factor of hepatic encephalopathy. This study aimed to investigate whether zinc deficiency predicts OHE occurrence and mortality in LC patients with MHE.</jats:p></jats:sec><jats:sec><jats:title>Method</jats:title><jats:p>This retrospective study included 100 LC patients with MHE. MHE was diagnosed using a computer‐aided neuropsychiatric test. Predictors associated with the development of OHE were analyzed using the Fine–Gray competing risk regression model. Cox proportional hazards regression analysis was carried out to evaluate the risk factors of mortality. Survival rates were analyzed using the Kaplan–Meier method and log‐rank test.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Of the 100 LC patients with MHE, 41% had zinc deficiency (<60 μg/dl). Zinc deficiency was observed more frequently in the patients with reduced liver function reserve. During the median follow‐up period of 9.9 months, 16% of the patients with MHE developed OHE. The patients with zinc deficiency had a higher risk of OHE than those without zinc deficiency (<jats:italic>p</jats:italic> = 0.03). Zinc deficiency was also associated with poor survival (<jats:italic>p</jats:italic> = 0.004). Multivariate analyses showed that zinc predicts the development of OHE (subdistribution hazard ratio [HR], 0.95; 95% confidence interval [CI], 0.92–0.99; <jats:italic>p</jats:italic> = 0.008) and mortality (HR, 0.96; 95% CI, 0.93–0.99; <jats:italic>p</jats:italic> = 0.02), independently of liver function reserves.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Zinc deficiency is likely to be a predictor of both OHE development and mortality in LC patients with MHE.</jats:p></jats:sec>