Clinical Outcomes of Oral Zinc Therapy in Hepatic Encephalopathy Treatment

Ann Pharmacother. 2023 Aug;57(8):899-906. doi: 10.1177/10600280221134283. Epub 2022 Nov 11.

Abstract

Background: Additional therapies for hepatic encephalopathy (HE) treatment are warranted. There are data evaluating the use of zinc for HE; however, clinical outcomes, specifically in the United States, are unknown.

Objective: To compare 30-day and 1-year all-cause readmission rates in patients with cirrhosis complicated by HE on lactulose and rifaximin to those on lactulose, rifaximin, and zinc.

Methods: This retrospective study included patients admitted with documented cirrhosis and home medications of lactulose and rifaximin, with or without zinc. Patients were stratified into 2 groups: those receiving lactulose and rifaximin for HE (control) and those receiving lactulose, rifaximin, and zinc for HE (treatment). The primary outcomes were 30-day and 1-year all-cause readmission rates.

Results: One-hundred fifty-seven patients were included (102 in control group, 55 in treatment group). Regarding 30-day and 1-year all-cause readmission rates, there was no difference between the control and treatment groups.

Conclusion and relevance: This is the first study conducted in the United States evaluating zinc for HE treatment. Zinc did not impact 30-day or 1-year all-cause readmission rates. Further studies are warranted to evaluate the potential benefit of zinc for HE, possibly in correlation with Model for End-stage Liver Disease-Sodium (MELD-Na) scores.

Keywords: cirrhosis; hepatic encephalopathy; lactulose; readmission; rifaximin; zinc.

MeSH terms

  • Drug Therapy, Combination
  • End Stage Liver Disease* / drug therapy
  • Gastrointestinal Agents / therapeutic use
  • Hepatic Encephalopathy* / complications
  • Hepatic Encephalopathy* / drug therapy
  • Humans
  • Lactulose / therapeutic use
  • Liver Cirrhosis / complications
  • Liver Cirrhosis / drug therapy
  • Retrospective Studies
  • Rifamycins* / therapeutic use
  • Rifaximin / therapeutic use
  • Severity of Illness Index
  • Zinc / therapeutic use

Substances

  • Rifaximin
  • Lactulose
  • Gastrointestinal Agents
  • Rifamycins
  • Zinc