# Clinical Evaluation of Oxidative Stress Biomarkers in Cirrhosis: Associations with Child–Pugh Class and Hepatic Encephalopathy

## TL;DR

This study found that oxidative stress biomarkers like MDA are not useful for staging cirrhosis but may indicate the severity of hepatic encephalopathy.

## Contribution

The study evaluates the clinical utility of oxidative stress biomarkers in cirrhosis, revealing their association with encephalopathy severity.

## Key findings

- MDA and 8-iso-PGF2α levels did not differ significantly between Child–Pugh classes or ascites severity.
- MDA levels increased significantly with the severity of hepatic encephalopathy.
- Oxidative stress biomarkers showed limited value for cirrhosis staging but potential relevance for encephalopathy assessment.

## Abstract

Background/Objectives: Oxidative stress contributes to the pathogenesis of cirrhosis, but its value as a clinical biomarker remains uncertain. Methods: We retrospectively analysed 90 patients with decompensated cirrhosis. Serum malondialdehyde (MDA) and 8-epi-prostaglandin F2α (8-iso-PGF2α) were measured at admission. Biomarker levels were compared between Child–Pugh classes B and C, across hepatic encephalopathy grades, and ascites severity, using Mann–Whitney, Kruskal–Wallis, and Spearman correlation tests. Results: Median MDA did not differ significantly between Child–Pugh classes B and C (2.67 [2.10–3.20] vs. 2.45 [1.98–3.05] μmol/L; p = 0.331), nor across ascites categories (p = 0.453). Similarly, 8-iso-PGF2α values did not vary between Child–Pugh classes (255.8 [220.0–310.0] vs. 250.1 [210.0–295.0] pg/mL; p = 0.784) or ascites groups (p = 0.828). Spearman analysis showed no significant correlations with albumin, INR, bilirubin, creatinine, or age, except for a non-significant trend with bilirubin (ρ = −0.18, p = 0.09). Importantly, MDA levels increased significantly across encephalopathy grades (p = 0.021), suggesting a link between systemic oxidative stress and neuropsychiatric impairment. Conclusions: In this clinical cohort, oxidative stress biomarkers did not provide discriminatory value for staging by Child–Pugh or ascites, but MDA was associated with encephalopathy severity. These findings highlight both the limitations and potential clinical relevance of oxidative stress markers in cirrhosis management.