Association of serum zinc levels with liver function and survival in patients awaiting liver transplantation
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Zinc is an important trace element with catalytic and defensive functions. We assessed the impact of zinc deficiency in patients with end-stage liver disease awaiting liver transplantation.
Serum zinc levels were measured at the time of evaluation for liver transplantation (n = 368). Patients were dichotomized in two groups based on low and normal zinc serum levels.
Serum zinc levels are tightly associated with liver function as patients with low zinc levels (n = 226) had a higher Model for End-Stage Liver Disease (MELD) score (15.0 [5.0–40.0]) than patients with normal zinc (n = 142) levels (9.0 [6.0–34.0]; p < 0.00). Multivariate analysis demonstrated that serum zinc levels function as an independent predictor of hepatic decompensation (hydropic decompensation: odds ratio [OR] 0.82; 95 % confidence interval [CI] 0.70–0.96; p = 0.015; hepatic encephalopathy: OR 0.80; 95 % CI 0.71–0.90; p = 0.000; spontaneous bacterial peritonitis: OR 0.85; 95 % CI 0.72–1.00; p = 0.047; hepatorenal syndrome: OR 0.83; 95 % CI 0.72–0.95; p = 0.011). Actuarial survival free of liver transplantation was reduced for low-zinc patients (26.7 ± 4.0 months; 95 % CI 18.8–34.6) compared to patients with normal zinc levels (30.9 ± 3.0 months; 95 % CI 24.9–36.9; p = 0.008). Reduction of zinc levels for patients on the transplantation list resulted in a 28.3-fold increased risk of death/liver transplantation (95 % CI 3.2–244.8, p < 0.001).
Serum zinc levels are associated with reduced survival in end-stage liver disease patients. Whether or not zinc supplementation might be beneficial for patients on a liver transplantation list requires further study.
KeywordsSerum zinc levels Liver transplantation End-stage liver disease Actuarial survival free of liver transplantation
DNG was funded by a grant of the Deutsche Forschungsgemeinschaft.
Conflicts of interest
Study concept and design: KF, WS, DNG
Acquisition of data: KF, CB, AW, CA, CR, CNH, MD
Analysis and interpretation of data: KF, DNG, KHW, PS, PS
Critical revision of the manuscript: PS, PS, KHW, CA, CNH, MD, SGS
Statistical analysis: KF, DNG
Technical or material support: KF, CB, DNG
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