Correlation between interleukin-6 and ammonia in patients with overt hepatic encephalopathy due to cirrhosis

SummaryObjectivePrevious studies have shown that elevated serum levels of interleukin-6 (IL-6) correlate with the severity of overt hepatic encephalopathy (OHE) in cirrhotic patients. However, the correlation between serum IL-6 levels and plasma ammonia levels in these patients remains unclear. Therefore, the present study investigated this correlation between both variables in cirrhotic patients with OHE.MethodsFifty-five cirrhotic patients with various grades of OHE, 29 cirrhotic patients without OHE, and 30 healthy controls were recruited. Concentrations of plasma ammonia and serum IL-6 were simultaneously measured.ResultsIn cirrhotic patients with OHE, the severity of OHE, represented by the West Haven criteria, correlated with serum IL-6 levels (r = 0.43, P < 0.05) and plasma ammonia levels (r = 0.59, P < 0.05). IL-6 and ammonia were found to be significant independent predictors of OHE severity (P < 0.05 for both variables). Furthermore, the severity of liver cirrhosis, determined by Child-Pugh scores, correlated with serum IL-6 levels (r = 0.45, P < 0.05) and plasma ammonia levels (r = 0.68, P < 0.05) in these patients. Moreover, there was a significant positive correlation between serum IL-6 levels and plasma ammonia levels (r = 0.58, P < 0.05) in cirrhotic patients with OHE, but not in patients without OHE (r = 0.42, P > 0.05) or healthy controls (r = 0.27, P > 0.05). The correlation between IL-6 and ammonia was independent of infectious precipitating factors.ConclusionsThe results of the present study suggest that IL-6 might be involved in the mechanism by which ammonia contributes to the pathogenesis of OHE. There is also evidence of a potential synergistic interaction between proinflammatory cytokines and ammonia in the pathogenesis of OHE.