Correlation of Trace Elements in Patients of Chronic Liver Disease with Respect to Child- Turcotte- Pugh Scoring System.

Introduction: Zinc, copper, manganese and magnesium are essential trace elements whose role in chronic liver disease and its complications is not clear.

Aim: To study the concentration of these elements in patients with Chronic Liver Disease (CLD) with respect to Child-Torcotte-Pugh (CTP) scoring.

Materials and Methods: This was an observational study carried out in the Department of Medicine, JSS Hospital, Mysore, India, between October 2013 and October 2015. A total of 75 patients with cirrhosis were prospectively enrolled. Severity of liver disease was assessed based on CTP score and patients were grouped into Class A, B and C. Routine investigations were done and following trace elements were assessed in all-zinc, copper, manganese and magnesium.

Results: The serum concentrations of zinc decreased with severity of liver disease, and the mean difference between different severity classes was statistically significant (p<0.001). There was a significant negative correlation between zinc and CTP Score (r= -0.439; p<0.001). Copper concentration was increased in patients with more severe cirrhosis and mean level difference of copper among the CTP groups were statistically significant (p<0.001). Moreover, copper showed significant positive correlation with CTP Score (r=0.385; p<0.001). The serum levels of manganese were significantly higher in patients with CTP C class in comparison to patients with CTP A and B class (p<0.05); Manganese showed significant positive correlation with CTP Score (r=0.271; p= 0.019). The concentrations of magnesium did not differ significantly between CTP class with the mean level difference not statistically significant.

Conclusion: Increasing liver dysfunction alters the metabolism of trace elements towards excess of copper and deficiency of zinc.