Observational Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 7, 2016; 22(17): 4397-4402
Published online May 7, 2016. doi: 10.3748/wjg.v22.i17.4397
Clinical scenarios for the use of S100β as a marker of hepatic encephalopathy
Andrés Duarte-Rojo, Astrid Ruiz-Margáin, Ricardo U Macias-Rodriguez, Francisco Javier Cubero, José Estradas-Trujillo, Rosa Ma Muñoz-Fuentes, Aldo Torre
Andrés Duarte-Rojo, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States
Astrid Ruiz-Margáin, Ricardo U Macias-Rodriguez, José Estradas-Trujillo, Rosa Ma Muñoz-Fuentes, Aldo Torre, Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14000, Mexico
Astrid Ruiz-Margáin, Ricardo U Macias-Rodriguez, Francisco Javier Cubero, Department of Internal Medicine III, University Hospital RWTH Aachen, 52074 Aachen, Germany
Francisco Javier Cubero, Department of Immunology, Complutense University School of Medicine, 28040 Madrid, Spain
Author contributions: Duarte-Rojo A and Ruiz-Margáin A contributed equally to this article; Duarte-Rojo A and Torre A contributed to study conception and design; Ruiz-Margáin A, Estradas-Trujillo J and Muñoz-Fuentes RM contributed to data acquisition; Duarte-Rojo A, Ruiz-Margáin A, Macias-Rodriguez RU contributed to data analysis and interpretation; Duarte-Rojo A, Ruiz-Margáin A, Macias-Rodriguez RU and Cubero FJ contributed writing the manuscript; Duarte-Rojo A, Cubero FJ and Torre A contributed to editing, reviewing and final approval of the article; and Torre A provided the funding for the project.
Supported by CONACYT/UNAM and FUNDACIÓN PARA LA SALUD Y LA EDUCACIÓN DR. SALVADOR ZUBIRÁN A.C (To Macias-Rodriguez RU); CONACYT/UNAM (To Ruiz-Margáin A); Ramón y Cajal Researcher, No. RYC-2014-15242 (To Cubero FJ).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Aldo Torre, MD, MSc, Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Colonia Sección XVI, Tlalpan C.P., México City 14000, Mexico. detoal@yahoo.com
Telephone: +52-155-54870900
Received: January 30, 2016
Peer-review started: January 30, 2016
First decision: February 18, 2016
Revised: March 3, 2016
Accepted: March 18, 2016
Article in press: March 18, 2016
Published online: May 7, 2016
Abstract

AIM: To evaluate the association between serum concentrations of S100β in patients with cirrhosis and the presence of low grade hepatic encephalopathy (HE).

METHODS: This was a cross-sectional study. The population was categorized into four groups healthy subjects, cirrhosis without HE, cirrhosis with covert hepatic encephalopathy (CHE) and cirrhosis with overt HE. Kruskal-Wallis, Mann Whitney’s U with Bonferroni adjustment Spearman correlations and area under the ROC were used as appropriate.

RESULTS: A total of 61 subjects were included, 46 cirrhotic patients and 15 healthy volunteers. S100β values were different among all groups, and differences remained significant between groups 1 and 2 (P < 0.001), and also between groups 2 and 3 (P = 0.016), but not between groups 3 and 4. In cirrhotic patients with HE S100β was higher than in patients without HE [0.18 (0.14-0.28) ng/mL vs 0.11 (0.06-0.14) ng/mL, P < 0.001]. There was a close correlation between serum concentrations of S100β and psychometric hepatic encephalopathy score in patients with cirrhosis without HE compared to the patients with cirrhosis with CHE (r = -0.413, P = 0.019). ROC curve analysis yielded > 0.13 ng/mL as the best cutoff value of S100β for the diagnosis of HE (sensitivity 83.3%, specificity 63.6%).

CONCLUSION: Serum concentrations of S100β are higher in patients with cirrhosis than in healthy volunteers, and are further increased in the presence of hepatic encephalopathy. The results suggest that serum biomarkers such as S100β could help in the correct characterization of incipient stages of HE.

Keywords: Hepatic encephalopathy, S100β protein, Astrocyte, Psychometric hepatic encephalopathy score, Critical flicker frequency

Core tip: Hepatic encephalopathy is a complication present in 30%-80% of the patients with cirrhosis and it is associated with increased mortality, adverse clinical outcomes, and poor quality of life. An increased concern about early recognition of this complication has risen in recent years; however, no biochemical marker is available to date. In this paper we evaluated the performance of S100β as a biochemical marker to identify the early stages of HE, and its correlation with neuropsychometric tests.