Hematological Indicators as Valuable Indices of Hepatic Encephalopathy in Patients with Liver Cirrhosis

Abstract

Background and study aim: Hepatic encephalopathy (HE) exacerbates morbidity and delays hospital discharge, indices derived from peripheral blood parameters, such as the albumin/platelet product (APP), mean platelet volume (MPV), and red cell distribution width (RDW), have gained interest as potential prognostic markers in cirrhosis have been proposed as non-invasive markers of fibrosis, but their prognostic role in HE remains under explored. The aim of the present work is to validate the effectiveness of Hematological indicators as valuable prognostic indices of hepatic encephalopathy in patients with liver cirrhosis.Patients and Methods: This prospective case–control study included 80 participants divided into three groups: Group I, 40 cirrhotic patients with HE (further subdivided by HE grade); Group II, 20 cirrhotic patients without HE; and Group III, 20 healthy controls.All participants underwent detailed clinical evaluation, including HE grading, routine laboratory tests, and abdominal ultrasonography. FIB-4 and APRI were calculated in addition to APP and other hematological products. Data were analysed using SPSS v20.0. Comparative analyses employed ANOVA or Kruskal–Wallis tests as appropriate, with post-hoc tests for subgroup comparisons. A p-value <0.05 was considered statistically significant.Results: Platelet count and mean platelet volume (MPV) showed significant differences across the groups (p<0.001). APP levels were significantly reduced in HE patients compared with cirrhotic and healthy controls, correlating with the severity of HE. Hemoglobin and WBC counts showed no significant differences. APP showed a significant negative correlation with MELD score (r = –0.386, p = 0.014), while associations with Child-Pugh, APRI, and FIB-4 were weaker and non-significant. Regarding patient survival, Patients who died (n = 11) had significantly higher MPV, MPV/PLT ratio, RDW, and RDW/PLT ratio compared with survivors (n = 29). ROC analysis of APP demonstrated an AUC of 0.755 (95% CI: 0.597–0.914, p = 0.014). At a cutoff of ≤0.174, APP predicted mortality with 63.6% sensitivity and 79.3% specificity.Conclusion: Hematological indices are valuable, non-invasive predictors of HE in cirrhotic patients. Incorporating these markers into routine clinical assessment may enhance early identification and prognostication.