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Subject Area

Ophthalmology

Article Type

Review

Abstract

Objective To study serum endotoxin in patients with liver cirrhosis with and without hepatic encephalopathy (HE). Background HE is a common complication of liver cirrhosis. Studies suggest that endotoxin and ammonia play an important role in its pathogenesis. Patients and methods This prospective study was conducted from November 2016 to May 2017 on 30 patients with liver cirrhosis without HE as group I, 30 patients with HE (group II) and 30 age-matched and sex-matched healthy individual as the control group. All were subjected to history taking, complete medical examination, and thorough laboratory and radiological investigations. Serum endotoxin was measured by enzyme-linked immunosorbent assay technique and arterial ammonia was measured by the enzymatic method. Results There were significant increase in endotoxin and arterial ammonia in cirrhotic patients than controls, with the highest levels in group II and higher levels in comatosed patients than those in precoma. There was a positive correlation between endotoxin and ammonia in group I (r = 0.62, P < 0.001) and group II (r = 0.92, P < 0.001). To predict cirrhosis, serum endotoxin had a sensitivity of 92%, specificity of 80%, and a cutoff point of 0.28 EU/ml, while at a cutoff point of 38 μmol/l arterial ammonia had a sensitivity of 80 and a, specificity of 77%. To predict HE, serum endotoxin had a sensitivity of 93%, specificity of 77% at a cutoff point of 0.42 EU/ml, while at a cutoff point of 75.5 μmol/l arterial ammonia had a sensitivity of 80% and a specificity of 73%. Conclusion Serum endotoxin and arterial ammonia were elevated in patients with liver cirrhosis with higher levels in HE and the highest in hepatic coma.

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