ASSESSMENT OF MINIMAL HEPATIC ENCEPHALOPATHY IN PATIENTS WITH MULTIPLE MYELOMA

Objectives. Multiple myeloma and its chemotherapeutic treatment can lead to morphological changes in the liver, which may not always be reflected in routine blood chemistry results. Minimal hepatic encephalopathy (MHE) is characterized by subtle motor and cognitive impairments that are not detectable through standard physical examination. The aim of this study was to determine the incidence of MHE in patients with progressive multiple myeloma. Materials and methods. The study group (Group I) consisted of 18 patients with progressive multiple myeloma. The control group (Group II) included 18 clinically healthy individuals. All patients in Group I underwent general clinical and biochemical blood tests. To diagnose minimal hepatic encephalopathy, the number connection test was used. Results. The most frequent CRAB (C, calcium; R, renal insufficiency; A, anemia; B, bone lesions) – criterion in patients of Group I was lytic bone lesions, detected in 100% (18/18) of patients. The presence of metaplastic anemia was diagnosed in 88.9% (16/18) of patients, confirmed by a decrease in erythrocyte and hemoglobin levels by 1.3 and 1.31 times, respectively, compared with the Group II (p<0.001). The level of total protein in the blood serum in Group I increased by 1.18 times (p<0.05), creatinine by 1.85 times (p<0.01), urea by 2.47 times, and alkaline phosphatase by 1.34 times compared to the control. Increased activity of liver enzymes was recorded in 11.1% (2/18) of patients. In Group I, the development of anemia correlated with renal dysfunction, as evidenced by the presence of an inverse correlation between red blood cell count and creatinine concentration (r=-0.73; p<0.05 by Pearson’s correlation). Minimal manifestations of cognitive dysfunction were recorded in 88.8% (16/18) of patients before the initiation of specific chemotherapy. The distribution of patients according to the severity of cognitive impairment was as follows: 0-I degree in 16.6% (3/18) of patients, I-II degree in 22.2% (4/18), II-III degree in 50.0% (9/18) of patients. Thus, changes in liver enzyme activity did not correlate with the results of the number connection test. Conclusion. Latent hepatic encephalopathy may develop even when biochemical parameters, particularly liver enzyme levels, remain within normal ranges. Therefore, its possible presence should be considered in patients regardless of the absence of overt biochemical abnormalities.