Correlation of Serum Magnesium Levels with Severity of Hepatic Encephalopathy in Patients with Liver Cirrhosis: A Cross-sectional Study from Eastern India

Aim and background: Hepatic encephalopathy (HE) is a serious neuropsychiatric complication of liver cirrhosis that significantly worsens patient outcomes and overall prognosis.Magnesium deficiency is commonly observed in cirrhosis and may contribute to neuronal dysfunction and worsening of encephalopathy.The present study aimed to evaluate the relationship between serum magnesium levels and the severity of HE in patients with liver cirrhosis admitted to a tertiary care hospital in Eastern India.Materials and methods: This facility-based cross-sectional observational study included 138 adult patients with cirrhosis and HE admitted between January 2023 and May 2024.Hepatic encephalopathy was graded using the West Haven criteria, and liver disease severity was assessed using the Child-Turcotte-Pugh (CTP) classification.Serum magnesium and other biochemical parameters were measured.Statistical analysis included Chi-square testing and Pearson's correlation to assess the association between serum magnesium levels and HE severity. Results:The mean age of the patients was 48.4 years, with a male predominance (73.2%).Alcohol was the most common etiology of cirrhosis (64.5%).Hypomagnesemia (serum magnesium <1.7 mg/dL) was present in 60.1% of patients.According to West Haven grading, 39.1% had grade I, 47.8% had grade II, and 13.1% had grade III HE.Most patients (61.9%) belonged to CTP class C. In-hospital mortality was 9.4%, occurring predominantly among patients with advanced encephalopathy and decompensated cirrhosis.Serum magnesium levels showed a significant inverse correlation with HE severity (r = -0.641,p < 0.01).Conclusion: Hypomagnesemia is highly prevalent in cirrhotic patients with HE and correlates significantly with disease severity and adverse outcomes.Clinical significance: Routine assessment of serum magnesium levels may help identify cirrhotic patients at higher risk of severe HE.Early correction of magnesium deficiency could serve as a simple and cost-effective adjunct to standard management strategies.