Manganese and hepatic encephalopathy: a prospective study

Introduction

We hypothesized that the manganese (Mn) concentration in the blood in cases of acute liver failure (ALF) and acute-on-chronic liver failure (ACLF) is associated with the Mn concentration in the liver tissue and cerebral globus pallidum and could be a marker of hepatic encephalopathy.

Methods

Mn blood tests were performed for 129 patients (54 patients of control group, 29 with ALF and 46 with ACLF) admitted to the ICU from October 2003 to July 2005, and pathological samples of liver and brain tissues were analyzed from 34 dead patients whose relatives gave their consent for this procedure (10 of control, 11 of ALF and 13 of ACLF). The Mn concentration in the vein blood and organs was analyzed by graphite furnace atomic absorption spectroscopy.

Results

The Mn concentration in the blood was significantly different (P < 0.04) in ALF (0.76 ± 0.06) and ACLF (1.04 ± 0.1) groups without significant difference between these two groups and the control group. The Mn concentration in the liver tissue was significantly different between all groups of patients (P < 0.026): the biggest one in ACLF patients (7.58 ± 1.0), and the smallest one in ALF patients (4.17 ± 0,7). The Mn concentration in the cerebral globus pallidum was also significantly different between all groups of patients (P < 0.03): the highest one in ACLF patients (4.17 ± 0.34), and the lowest one in ALF patients (1.71 ± 0.2). No statistically significant correlation was found between Mn concentrations in the tissues (P ≥ 0.075) either in ALF or in ACLF groups of patients.

Conclusion

The Mn concentration in the blood was not confirmed as a marker of hepatic encephalopathy in cases of acute and acute-on-chronic liver failure.