Nitric Oxide, Ammonia, and CRP Levels in Cirrhotic Patients With Hepatic Encephalopathy: Is There a Connection?

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http://journals.lww.com/jcge/Abstract/2010/11000/Nitric_Oxide,_Ammonia,_and_CRP_\

Levels_in_Cirrhotic.16.aspx

Journal of Clinical Gastroenterology:

November/December 2010 - Volume 44 - Issue 10 - pp 713-719

doi: 10.1097/MCG.0b013e3181d47f71

LIVER, PANCREAS AND BILIARY TRACT: Original Articles

Nitric Oxide, Ammonia, and CRP Levels in Cirrhotic Patients With Hepatic

Encephalopathy: Is There a Connection?

Papadopoulos, Nikolaos MD

Abstract

Goals: Comparison of nitric oxide (NO) levels in cirrhotic patients with and

without hepatic encephalopathy (HE), evaluation of possible correlation between

HE and other clinical or laboratory characteristics, and estimation of

utilization of NO levels in clinical practice.

Background: HE is a neuropsychiatric complication of cirrhosis. The exact

pathogenetic mechanisms underlying the presence of HE are not known. However,

dysfunction of the NO pathway and ammonia detoxification are thought to play a

major role.

Study: Sixty-seven cirrhotic patients, 36 (53.7%) without HE, and 31 (46.3%)

with HE were included in the study. Eighteen healthy individuals were used as

control group. Clinical and laboratory data, including ammonia and stable end

products of NO using Griess reaction, were collected.

Results: NOx levels were statistically significantly higher in cirrhotic

patients (225.5 μmol/L) than in control group [(67.94 μmol/L) (P=0.000)].

NOx levels were, also, statistically significantly higher in patients with HE

compared with patients without HE (324.67 μmol/L vs. 141.96 μmol/L,

P=0.000). Significant correlation between the presence of HE and NOx, ammonia,

C-reactive protein, albumin, Model for End-Stage Liver Disease score, and

Child-Pugh classification revealed. NOx levels also correlated with severity of

HE. NOx and ammonia are independent factors predicting HE according to

regression analysis. Diagnostic accuracy for the diagnosis of HE using a

combination of NOx and ammonia was superior compared with standalone NOx or

ammonia utilization.

Conclusions: NOx levels are correlated with the presence and severity of HE. NOx

levels determination, in addition to ammonia levels, could contribute in

diagnosis of HE.

© 2010 Lippincott & Wilkins, Inc.