Manzo MGA, Audu N, Musa Y, Muktar AA, Samaila AA, Borodo MM. Serum zinc levels, hepatic encephalopathy, and liver disease severity in decompensated chronic liver disease patients in Kano, Nigeria. World J Transl Med 2026; 12(3): 124154 [DOI: 10.5528/wjtm.124154]
Corresponding Author of This Article
Yusuf Musa, MD, Chief Physician, Consultant, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Federal Teaching Hospital Katsina, Murtala Muhammad Way, Opposite Jibia Road, Katsina 820101, Nigeria. yusuf.musa@npmcn.edu.ng
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Gastroenterology & Hepatology
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Manzo MGA, Audu N, Musa Y, Muktar AA, Samaila AA, Borodo MM. Serum zinc levels, hepatic encephalopathy, and liver disease severity in decompensated chronic liver disease patients in Kano, Nigeria. World J Transl Med 2026; 12(3): 124154 [DOI: 10.5528/wjtm.124154]
World J Transl Med. Sep 28, 2026; 12(3): 124154 Published online Sep 28, 2026. doi: 10.5528/wjtm.124154
Serum zinc levels, hepatic encephalopathy, and liver disease severity in decompensated chronic liver disease patients in Kano, Nigeria
Mohammed Gadafi Ahmed Manzo, Nuruddeen Audu, Yusuf Musa, Aliyu Abba Muktar, Adamu Alhaji Samaila, Musa Muhammad Borodo
Mohammed Gadafi Ahmed Manzo, Adamu Alhaji Samaila, Musa Muhammad Borodo, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Aminu Kano Teaching Hospital, Kano 700101, Nigeria
Nuruddeen Audu, Department of Internal Medicine, Federal University of Health Science Teaching Hospital, Azare 751101, Bauchi, Nigeria
Yusuf Musa, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Federal Teaching Hospital Katsina, Katsina 820101, Nigeria
Aliyu Abba Muktar, Center for Biotechnology Research, Bayero University, Kano 700001, Nigeria
Author contributions: Manzo MGA, Audu N, and Musa Y contributed to the conception of the study and drafting of the manuscript; Muktar AA supervised the zinc analysis; Samaila AA and Borodo MM contributed to manuscript drafting, critical revision, and editing; Samaila AA and Borodo MM also served as guarantors of the work. All authors read and approved the final manuscript.
AI contribution statement: AI tools, specifically the free versions of ChatGPT and Grammarly, were used solely for language editing, grammatical correction, and formatting assistance. No AI tool was used to generate research data, analyze or interpret the results, or formulate the study conclusions. All AI-assisted outputs were critically reviewed, revised, and approved by the authors.
Institutional review board statement: Ethical approval was obtained from the Human Research and Ethics Committee of Aminu Kano Teaching Hospital (approval No. NHREC/28/01/2020/AKTH/EC/3546). The study adhered to the principles of the Declaration of Helsinki (2013 revision).
Informed consent statement: Written informed consent was obtained from all participants.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: No additional data are available.
Corresponding author: Yusuf Musa, MD, Chief Physician, Consultant, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Federal Teaching Hospital Katsina, Murtala Muhammad Way, Opposite Jibia Road, Katsina 820101, Nigeria. yusuf.musa@npmcn.edu.ng
Received: June 9, 2026 Revised: July 7, 2026 Accepted: July 28, 2026 Published online: September 28, 2026 Processing time: 87 Days and 14.8 Hours
Abstract
BACKGROUND
Hepatic encephalopathy (HE) is a complex neurological process that is seen in advanced liver disease. The onset of HE in patients with liver disease is a critical indicator of decompensation and is associated with poor outcomes. Many studies have shown a fall in serum zinc with advancing chronic liver disease (CLD) and higher grades of HE. There are, however, conflicting results on the benefit of zinc supplementation in HE.
AIM
To determine the association between serum zinc, HE, and liver disease severity in decompensated CLD (DCLD) patients in Kano.
METHODS
We conducted a comparative cross-sectional study at a Nigerian tertiary hospital. Eighty DCLD patients with HE and 80 matched controls (16 per HE grade) were recruited. The diagnosis of DCLD combined clinical, laboratory, and ultrasound assessments. We graded liver disease severity with the Child-Pugh score and staged HE using the West Haven classification. Serum zinc was measured using atomic absorption spectrophotometry. Spearman’s correlation explored associations, with P < 0.05 considered significant. The study adhered to standard ethical principles.
RESULTS
The median serum zinc level in CLD patients was 0.381 mg/L [interquartile range (IQR) = 0.16]. This value was lower than that of the controls, which was 0.89 mg/L (IQR = 0.09). Serum zinc decreased with increasing HE grade, and this was found to be statistically significant (correlation coefficient, r = -0.601; P value < 0.001). There was a significant negative correlation between serum zinc levels in CLD subjects and the Child-Pugh class (r = -0.547; P value < 0.001). Serum bilirubin, prothrombin time (PT), and international normalized ratio (INR) also had a statistically significant negative correlation with serum zinc levels.
CONCLUSION
Serum zinc levels are significantly reduced in CLD and show inverse correlations with the severity of HE, Child-Pugh class, bilirubin, PT, and INR.
Core Tip: Zinc deficiency is frequently seen in patients with decompensated chronic liver disease (DCLD) and appears to worsen as liver disease progresses. In this study, serum zinc levels were significantly lower in DCLD patients and were inversely related to both hepatic encephalopathy (HE) and Child-Pugh class. This suggests that low serum zinc may reflect worsening liver dysfunction. Recent guidelines recommend serum zinc assessment in HE patients not responding to standardized treatment, and a conditional recommendation for zinc supplementation in those found deficient. This reflects the evolving role of zinc both as a biomarker and therapeutic target.
