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
- 11.Hoffmann K, Hinz U, Hillebrand N, Ganten T, Gotthardt D, Longerich T, Schirmacher P et al (2014) The MELD score predicts the short-term and overall survival after liver transplantation in patients with primary sclerosing cholangitis or autoimmune liver diseases. Langenbecks Arch Surg 399:1001–1009CrossRefPubMedGoogle Scholar
- 25.Kang X, Zhong W, Liu J, Song Z, McClain CJ, Kang YJ, Zhou Z (2009) Zinc supplementation reverses alcohol-induced steatosis in mice through reactivating hepatocyte nuclear factor-4 alpha and peroxisome proliferator-activated receptor-alpha. Hepatology 50:1241–1250PubMedCentralCrossRefPubMedGoogle Scholar
- 26.Zhou Z, Kang X, Jiang Y, Song Z, Feng W, McClain CJ, Kang YJ (2007) Preservation of hepatocyte nuclear factor-4alpha is associated with zinc protection against TNF-alpha hepatotoxicity in mice. Exp Biol Med (Maywood) 232:622–628Google Scholar