Correlation of Serum Zinc Levels with Hepatic Encephalopathy Severity in Patients with Decompensated Liver Cirrhosis: A Prospective Observational Study from Egypt.

A vital trace element, zinc, is involved in several metabolic and enzymatic functions, such as antioxidant defense and ammonia detoxification. Zinc metabolism is disturbed by liver cirrhosis, especially when it is decompensated, contributing to systemic complications, including hepatic encephalopathy (HE). This study aimed to assess serum zinc levels in patients with decompensated liver cirrhosis and evaluate their correlation with the severity of cirrhosis and HE grades. This prospective observational study included 100 patients with decompensated liver cirrhosis and 100 healthy controls between December 2022 and June 2023. Serum zinc levels and other biochemical parameters were measured using standard laboratory methods. Liver cirrhosis severity was evaluated using the Child-Pugh score, and HE was graded using the West Haven criteria. Correlations between zinc levels, clinical parameters, and disease severity were analyzed statistically by Spearman's correlation and Kruskal-Wallis tests. Serum zinc levels were significantly lower in cirrhotic patients compared to controls (21.7 ± 24.3 µg/dL vs. 85.9 ± 32.6 µg/dL, P < 0.0001). Zinc levels inversely correlated with both Child-Pugh class (r =  - 0.84, P < 0.001) and HE grade (r =  - 0.78, P < 0.001). Patients with advanced Child-Pugh Class C or HE Grade 3 had severe zinc deficiency. A strong positive correlation was observed between serum zinc and albumin levels (r = 0.843, P < 0.0001), underscoring albumin's role in zinc transport. Serum zinc deficiency is strongly correlated with the severity of liver cirrhosis and HE. Therefore, routine zinc assessment and supplementation should be considered in cirrhotic patients, especially those with hypoalbuminemia or advanced HE for better outcomes.