Study of interleukin 6 versus Ammonia and their prognostic values in children with minimal hepatic encephalopathy

Background: Hepatic encephalopathy (HE) is a serious neuropsychiatric complication of liver cirrhosis, ranging from minimal (subclinical) symptoms to severe overt manifestations. Key biomarkers like elevated ammonia levels and neuroinflammation, including elevated IL-6, are central to its pathogenesis. Cognitive impairment, poor quality of life, and elevated death and morbidity are found in affected children. Aim: To study the pattern of the increasing levels of IL6 and serum ammonia in children with cirrhosis and their prognostic values in cases with minimal hepatic encephalopathy (MHE (as well as their correlation with modified MMSE test and encephalopathy risk factors. Patients and methods: A cross-sectional case-control research has been performed at Mansoura University Children’s Hospital (Oct 2022–Oct 2023) including 63 children: 20 healthy, 22 with compensated cirrhosis, and 21 with decompensated cirrhosis, aged 8–18 years of both genders. Results: Insignificant variances have been observed in age or gender except for more females in the decompensated group. IL-6 and ammonia were significantly greater in cirrhotic cases than controls, with ammonia showing no difference between compensated and decompensated cases. Modified MMSE scores were significantly reduced in cirrhotic patients, especially in decompensated cases. IL-6 correlated with MMSE and EDS, while ammonia showed no significant correlations. ROC analysis demonstrated high diagnostic accuracy of IL-6 (AUC=0.98) compared to ammonia (AUC=0.81). Conclusion: Pediatric liver cirrhosis may be complicated by MHE, increasing risk of overt HE and mortality. Modified MMSE aids in screening, but lacks specificity. IL-6 is a promising biomarker, while ammonia alone is unreliable.