Evaluation of Interleukin-6 for stepwise diagnosis of minimal hepatic encephalopathy in patients with liver cirrhosis

Minimal hepatic encephalopathy (MHE) is associated with poor quality of life and dismal prognosis. Psychometric testing is time consuming and therefore often neglected in clinical practice. Thus, biomarkers are needed to stratify patients at risk for MHE.

This study aimed to evaluate the diagnostic accuracy of interleukin-6 (IL-6) serum levels as part of a stepwise diagnostic algorithm to detect MHE in cirrhotic patients.

The development cohort comprised 197 prospectively recruited patients without evidence of HE grade 1–4. 52 patients served as the independent validation cohort. The Psychometric Hepatic Encephalopathy Score (PHES) was used for MHE diagnosis.

In total, 50 (25.4%) patients of the development cohort were diagnosed with MHE. Serum IL-6 levels were more than twice as high in patients with MHE as in patients without MHE (16 vs 7 pg/ml, p < 0.001). In logistic regression analysis, elevated IL-6 levels remained independently associated with MHE (OR 1.036, 95%CI 1.009–1.064, p = 0.008) after adjusting for other variables such as MELD, albumin, CRP and history of ascites. Using a cut-off value of IL-6 ≥7 pg/ml would have avoided subsequent time-consuming psychometric testing in 38% of all patients (sensitivity 90%, 95%CI 77%-96%; negative predictive value 93%, 95%CI 84%-98%). These results were confirmed in the validation cohort (sensitivity: 94%, NPV: 93%).

IL-6 serum levels may serve as biomarker in a stepwise diagnostic algorithm reducing the number of patients requiring testing with PHES. In particular, IL-6 would be helpful in patients being incapable of performing other tests e. g., due to language barriers.

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Artikel online veröffentlicht:
26. Januar 2022