Metabolic syndrome is associated with poor response to rifaximin in minimal hepatic encephalopathy.

Autores de INCLIVA

• Maria Pilar Ballester Ferre

  Autor

• Juan José Gallego Roig

  Autor

• Alessandra Fiorillo

  Autor

• Franc Casanova Ferrer

  Autor

• Maria Desamparados Escudero Garcia

  Autor

• Joan Tosca Cuquerella

  Autor

• Cristina Monton Rodríguez

  Autor

• Jose Ballester Fayos

  Autor

• 

  Maria Amparo Urios Lluch

  Autor

• Teresa C. San Miguel Diez

  Autor

• 

  María Del Carmen Montoliu Félix

  Autor

Participantes ajenos a INCLIVA

• Gimenez-Garzo, Carla
• Rios, Maria-Pilar
• Durban, Lucia
• Benlloch, Salvador
• Kosenko, Elena
• Serra, Miguel-Angel
• Felipo, Vicente

Grupos y Plataformas de I+D+i

• Grupo de Investigación de Deterioro Neurológico

  

  Leading Researcher

  María Del Carmen Montoliu Félix

• Grupo de Investigación de Enfermedades Digestivas

  Leading Researcher

  Isabel Pascual Moreno

Abstract

Patients with cirrhosis may show minimal hepatic encephalopathy (MHE), for which rifaximin is effective. Metabolic syndrome may be associated with cognitive impairment. Our aims were to evaluate the influence of metabolic syndrome features on response to rifaximin for neurological and inflammatory alterations in MHE. A prospective cohort study was conducted in 63 cirrhotic patients and 30 controls from two tertiary centres recruited between 2015 and 2019. Metabolic syndrome was defined according to the Adult Treatment Panel-III. Patients were classified into 31 without and 32 with MHE according to the Psychometric Hepatic Encephalopathy Score (PHES). All participants performed specific psychometric tests, and inflammatory parameters were studied. Patients with MHE received rifaximin (400 mg/8 h). Response was evaluated by PHES at 3 and 6 months. Response according to metabolic syndrome manifestations was compared. The response rate was 66%. Older age (p = 0.012) and all metabolic syndrome diseases (p < 0.05) were associated with non-response, plus an increase in risk as the number of manifestations rose (p < 0.001). Patients with metabolic manifestations exhibited worse processing speed (p = 0.011), working memory (p = 0.005), visual coordination (p = 0.013) and lower proportion of activated CD4(+) lymphocytes (p = 0.039) at baseline, as well as worse concentration (p = 0.030), bimanual coordination (p = 0.004) and higher levels of intermediate monocytes (p = 0.026), CX3CL1 (p < 0.05), IL-17 (p = 0.022), AHR (p = 0.010) and IgG (p < 0.05) at 3 and/or 6 months of rifaximin. Patients with clinical signs of metabolic syndrome have poor response to rifaximin for MHE, with a higher proportion of neurological alterations associated with a pro-inflammatory environment.

© 2022. The Author(s).