[Arterial ketone body ratio as an indicator of energy charge in patients with hepatic encephalopathy].

Arterial ketone body ratio (AKBR) was continuously measured in 39 cases with hepatic encephalopathy (HE) in order to evaluate the immediate energy charge of the liver and predict the occurrence of HE and its prognosis. The results demonstrated that AKBR in patients before the onset of HE was significantly lower than that in healthy subjects (P < 0.005). AKBR was less than 0.65 when HE occurred. Patients were classified into three groups according to the value of AKBR. Patients in group A had AKBR above 0.7, patients in group B had a transient drop of AKBR to 0.4, and patients in group C had consistently low AKBR value of less than 0.4. The death rates in these three groups were 0, 33.3% (5/15) and 100% (14/14) respectively; the difference was quite significant (P < 0.001). Hepatic functional tests such as alanine transaminase, serum bilirubin, prothrombin time and albumin did not show such difference. Our findings suggest that AKBR can predict hepatic energy charge accurately. Patients whose AKBR value was consistently below 0.4 would have a poor prognosis.