Brain-Derived Neurotrophic Factor as a Potential Diagnostic Marker in Minimal Hepatic Encephalopathy

Abstract

Abstract Background Based on the etiology, liver cirrhosis is sub-classified into viral hepatitis (hepatitis B, C, and D), due to toxins (alcohol and drugs), autoimmune hepatitis, Cholestatic (primary biliary cholangitis, and primary sclerosing cholangitis), vascular (Budd-Chiari syndrome, sinusoidal obstruction syndrome, and cardiac cirrhosis), and metabolic causes (hemochromatosis, NASH, Wilson disease, alpha-1 antitrypsin deficiency, cryptogenic cirrhosis). Aim of the Work The aim of the current study is to detect Minimal Hepatic Encephalopathy (MHE) among cirrhotic patients of Child C with no or clinically manifest encephalopathy using Brain-Derived Neurotrophic Factor (BDNF) and study the diagnostic value of BDNF serum marker versus Psychometric Hepatic Encephalopathy Score (PHES) in detecting MHE. Patients and Methods 90 patients were enrolled into a clinical cross-sectional study. All patients gave informed written consent. Patients are divided equally into 3 groups, 30 patients each. Patients are either in-patient or out-patients in Ain shams University Hospitals. Group 1 The Examined Group (EG): includes 30 patients diagnosed as hepatitis C, cirrhotic, Child class C with no overt or clinically manifest encephalopathy. Group 2 The Hepatic Encephalopathy Group (HEG): includes 30 patients diagnosed as hepatitis C, cirrhotic, Child class C with overt or clinically manifest encephalopathy. Group 3 The Control Group (CG): includes 30 healthy individuals (volunteers). Results In the present study among the whole sample (n = 90), there was a significant positive correlation between PHES score & BDNF serum level with Hb, platelet count and albumin. While, there was a significant negative correlation between PHES score and BDNF serum level with AST, ALT, total bilirubin, direct bilirubin, INR and Child’s Score. On the other hand, Stawicka et al. 2021, reported that BDNF had a negative correlation with bilirubin (R = –0.35, p = 0.005) and international normalized ratio (INR) (R = –0.37, p = 0.003), and positive with platelets (R = 0.36, p = 0.004), while no associations with age, sex, body mass index (BMI), waist-hip ratio (WHR), creatinine and ammonia. Conclusion MHE constitutes a significant medical problem in a common patient population. Unfortunately, it is often underdiagnosed, likely related to the notion that testing is time consuming requiring highly specialized personnel. Additionally, the term ‘MHE’ may create the impression that this condition has limited impact on patient’s wellbeing; however, it has been shown that MHE has clinical implications on the patient as well as public safety concerns. Diagnosing and treating MHE is difficult owing to the subclinical nature of the disease. The use of Psychometric Hepatic Encephalopathy Score (PHES) and Brain-Derived Neurotrophic Factor could be of great help in early detection of the condition and to give suitable preventive treatment.