NON-ALCOHOLIC FATTY LIVER DISEASE IS A LEADING ETIOLOGICAL FACTOR IN THE FORMATION OF SUBCLINICAL HEPATIC ENCEPHALOPATHY IN PATIENTS WITH CIRRHOSIS AFTER COVID-19
DOI:
https://doi.org/10.11603/1811-2471.2024.v.i1.14535Keywords:
liver cirrhosis, hepatic encephalopathy, COVID-19, etiology (alcoholic liver disease, non-alcoholic fatty liver disease, viral liver disease)Abstract
SUMMARY. The study of the etiological factors of liver cirrhosis (LC) and their relationship with the formation and progression of hepatic encephalopathy (HE) in COVID-19 is an urgent problem of modern medicine.
The aim – to study the features of HE progression after COVID-19 depending on the etiological factor of LC.
Material and Methods. We examined 126 patients with LC and HE after COVID-19. All patients underwent general clinical examinations. The etiological factors of liver damage in these patients were characterised. Patients were divided into Child-Pugh severity classes, and the degree of HE was determined.
Results. The most frequent etiological factor in the development of LC in patients with COVID-19 is alcohol abuse (41.3 % of patients), as well as metabolic disorders in the form of non-alcoholic fatty liver disease (NAFLD), which preceded the development of LC (34.1 % of patients). Alcohol abuse (alcoholic liver disease (ALD)), which led to the formation of LC, was more common among men (3.3 times – p<0.01), while NAFLD was more common in female patients (1.5 times – p<0.05). NAFLD, which led to the formation of LC, after COVID-19 is more often manifested mainly by minimal signs of HE (in 77.8 % of latent HE and in 84.6 % of cases of grade I HE (p<0.001)). Severe signs of grade II and III HE were diagnosed mainly in patients with LC after COVID-19 in the setting of ALD and viral liver damage.
Conclusions. In the patients with cirrhosis examined by us, alcohol abuse (in 41.3 % of cases) and NAFLD (in 34.1 % of patients) are frequent etiological factors of liver damage. At the same time, LC of alcoholic etiology was more often diagnosed in men (76.9 % of the examined – p<0.01), while NAFLD was more often diagnosed in women (60.5 % of patients – p<0.05).
In patients with LC, the etiological factor of which is NAFLD, HE after COVID-19 has mainly minimal clinical signs, namely, in 77.8 % of patients, its latent course was established and in 84.6 % of patients - grade I HE, while in patients with LC on the background of ALD or viral damage, grade II and III HE was more often established.
References
Sharma, B., & John, S. (2023). Hepatic Cirrhosis. Treasure Island (FL): StatPearls Publishing. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK482419/.
Bruyneel, M., & Sersté, T. (2018). Sleep disturbances in patients with liver cirrhosis: prevalence, impact, and management challenges. Nat. Sci. Sleep., 10, 369-375. DOI: 10.2147/NSS.S186665. DOI: https://doi.org/10.2147/NSS.S186665
Nusrat, S., Khan, M.S., Fazili, J., & Madhoun, M.F. (2014). Cirrhosis and its complications: evidence based treatment. World J. Gastroenterol., 20(18), 5442-5460. DOI: 10.3748/wjg.v20.i18.5442. DOI: https://doi.org/10.3748/wjg.v20.i18.5442
Premkumar, M., & Anand, A.C. (2022). Overview of Complications in Cirrhosis. J. Clin. Exp. Hepatol., 12(4), 1150-1174. DOI: 10.1016/j.jceh.2022.04.021. DOI: https://doi.org/10.1016/j.jceh.2022.04.021
Amodio, P. (2018). Current diagnosis and classification of hepatic encephalopathy. J. Clin. Exp. Hepatol., 8, 432-437. DOI: 10.1016/j.jceh.2018.07.001. DOI: https://doi.org/10.1016/j.jceh.2018.07.001
Weissenborn, K. (2015). Diagnosis of minimal hepatic encephalopathy. J. Clin. Exp. Hepatol., 5(1), S54-S59. DOI: 10.1016/j.jceh.2014.06.005. DOI: https://doi.org/10.1016/j.jceh.2014.06.005
Chowdhury, T., Sultana, J., Dutta, J., Gousy, N., & Hassan, K.N. (2022). Rapid Turn From Cirrhosis to Encephalopathy Following COVID-19 Infection: A Cautionary Tale. Cureus., 14 (2), e22089. DOI: 10.7759/cureus.22089. DOI: https://doi.org/10.7759/cureus.22089
Wiesner, R.H. (2005). Evidence-based evolution of the MELD/PELD liver allocation policy. Liver Transpl., 11, 261-263. DOI: 10.1002/lt.20362. DOI: https://doi.org/10.1002/lt.20362
(2014). Unifikovanyy klinichnyy protokol pervynnoyi, vtorynnoyi (spetsializovanoyi) medychnoyi dopomohy alkoholnyy hepatyt. Nakaz ministerstva okhorony zdorovya ukrayiny vid 06.11.2014 r. № 826 – Unified clinical protocol for primary and secondary (specialised) medical care for alcoholic hepatitis. Order of the Ministry of Health of Ukraine dated 06.11.2014, 826 [in Ukrainian].
European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD), European Association for the Study of Obesity (EASO). (2016). EASL-EASD-EASO clinical practice guidelines for the management of nonalcoholic fatty liver disease. J. Hepatol., 64, 1388-1402. DOI: https://doi.org/10.1016/j.jhep.2015.11.004
Prakash, R., & Mullen, K.D. (2010). Mechanisms, diagnosis and management of hepatic encephalopathy. Nature Reviews Gastroenterology and Hepatology., 7(9), 515-525. DOI: 10.1038/nrgastro.2010.116. DOI: https://doi.org/10.1038/nrgastro.2010.116
