European journal of clinical nutrition · 2025
Risk factors, clinical outcomes, and the development of a pragmatic zinc deficiency screening tool in patients with cirrhosis: a prospective cohort study.
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Lakananurak Narisorn, Chanwigoon Phatcharaporn, Hathayamat Warasinee
Аннотация
BACKGROUND/OBJECTIVES: Zinc plays a crucial role in cirrhosis. Recent American College of Gastroenterology (ACG) guidelines recommend zinc supplementation for patients with cirrhosis and hypozincemia. However, standardized screening protocols remain unavailable, and routine serum zinc evaluation may not be cost-effective or appropriate. This study aims to determine the prevalence, risk factors, and clinical impact of zinc deficiency while developing a standardized tool for its evaluation.
SUBJECTS/METHODS: This prospective study included 110 patients with cirrhosis attending outpatient clinics. Serum zinc levels were measured, and data on demographics, cirrhosis severity, complications, and nutritional status were collected. Participants were monitored over a 6-month period to evaluate clinical outcomes.
RESULTS: Zinc deficiency was observed in 60% of patients and linked to new/worsening ascites (hazard ratio (HR) 2.8; 95%confidence interval (CI): 1.6-14.1; p = 0.021). Independent risk factors included female gender, non-hepatitis B/C cirrhosis, Child-Pugh B/C, and serum albumin <3.5 g/dL. A novel predictive tool, the Zinc-FANC score, was developed with the following criteria: Female gender (1 point), Albumin <3.5 g/dL (2 points), Non-hepatitis B/C (1 point), and Child-Pugh B/C (1 point). The score categorized patients into low-risk (score 0), medium-risk (scores 1-2), and high-risk (scores 3-5) groups. The high-risk group showed a specificity of 97.7%, while the low-risk group demonstrated a sensitivity of 95.5%.
CONCLUSION: Zinc deficiency was common and linked to adverse outcomes. The Zinc-FANC score demonstrates potential utility in guiding zinc screening protocols in patients with cirrhosis; however, external validation in diverse clinical settings is warranted before its implementation in routine practice.
SUBJECTS/METHODS: This prospective study included 110 patients with cirrhosis attending outpatient clinics. Serum zinc levels were measured, and data on demographics, cirrhosis severity, complications, and nutritional status were collected. Participants were monitored over a 6-month period to evaluate clinical outcomes.
RESULTS: Zinc deficiency was observed in 60% of patients and linked to new/worsening ascites (hazard ratio (HR) 2.8; 95%confidence interval (CI): 1.6-14.1; p = 0.021). Independent risk factors included female gender, non-hepatitis B/C cirrhosis, Child-Pugh B/C, and serum albumin <3.5 g/dL. A novel predictive tool, the Zinc-FANC score, was developed with the following criteria: Female gender (1 point), Albumin <3.5 g/dL (2 points), Non-hepatitis B/C (1 point), and Child-Pugh B/C (1 point). The score categorized patients into low-risk (score 0), medium-risk (scores 1-2), and high-risk (scores 3-5) groups. The high-risk group showed a specificity of 97.7%, while the low-risk group demonstrated a sensitivity of 95.5%.
CONCLUSION: Zinc deficiency was common and linked to adverse outcomes. The Zinc-FANC score demonstrates potential utility in guiding zinc screening protocols in patients with cirrhosis; however, external validation in diverse clinical settings is warranted before its implementation in routine practice.