The Crucial Role of Risk Factors when Dealing with Hepatic Encephalopathy

Overview

Journal Metab Brain Dis

Publisher Springer

Specialties Endocrinology
Neurology

Date 2024 Nov 21

PMID 39570425

Authors

Lucia Lapenna

Simone Di Cola

Manuela Merli

Affiliations

Soon will be listed here.

Abstract

Hepatic encephalopathy (HE) is a common condition in patients with cirrhosis, representing the second most frequent cause of decompensation. Approximately 30-40% of patients with cirrhosis will experience overt HE during the clinical course of their illness. In most cases, it is possible to identify a precipitating or risk factor for HE. These are distinct concepts that play different roles in the development of this condition. While precipitating factors act acutely, risk factors are generally present over an extended period and contribute to the overall likelihood of developing HE. The two types of factors require different approaches, with risk factors being more susceptible to prevention. The aim of this review is to describe the most important risk factors (such as severity of liver disease, previous episode of HE, minimal/covert HE, spontaneous and iatrogenic shunt, malnutrition, chronic therapies, metabolic diseases) for the development of HE and how to prevent it.

References

Ahluwalia V, Betrapally N, Hylemon P, White M, Gillevet P, Unser A . Impaired Gut-Liver-Brain Axis in Patients with Cirrhosis. Sci Rep. 2016; 6:26800. PMC: 4880966. DOI: 10.1038/srep26800. View

Amodio P, Bemeur C, Butterworth R, Cordoba J, Kato A, Montagnese S . The nutritional management of hepatic encephalopathy in patients with cirrhosis: International Society for Hepatic Encephalopathy and Nitrogen Metabolism Consensus. Hepatology. 2013; 58(1):325-36. DOI: 10.1002/hep.26370. View

Ampuero J, Ranchal I, del Mar Diaz-Herrero M, Antonio Del Campo J, Bautista J, Romero-Gomez M . Role of diabetes mellitus on hepatic encephalopathy. Metab Brain Dis. 2012; 28(2):277-9. DOI: 10.1007/s11011-012-9354-2. View

Bajaj J, Pinkerton S, Sanyal A, Heuman D . Diagnosis and treatment of minimal hepatic encephalopathy to prevent motor vehicle accidents: a cost-effectiveness analysis. Hepatology. 2011; 55(4):1164-71. PMC: 3319334. DOI: 10.1002/hep.25507. View

Ballester M, Gallego J, Fiorillo A, Casanova-Ferrer F, Gimenez-Garzo C, Escudero-Garcia D . Metabolic syndrome is associated with poor response to rifaximin in minimal hepatic encephalopathy. Sci Rep. 2022; 12(1):2463. PMC: 8844048. DOI: 10.1038/s41598-022-06416-z. View

Bernardi M, Gitto S, Biselli M . The MELD score in patients awaiting liver transplant: strengths and weaknesses. J Hepatol. 2010; 54(6):1297-306. DOI: 10.1016/j.jhep.2010.11.008. View

Bloom P, Tapper E, Young V, Lok A . Microbiome therapeutics for hepatic encephalopathy. J Hepatol. 2021; 75(6):1452-1464. PMC: 10471317. DOI: 10.1016/j.jhep.2021.08.004. View

Bohra A, Worland T, Hui S, Terbah R, Farrell A, Robertson M . Prognostic significance of hepatic encephalopathy in patients with cirrhosis treated with current standards of care. World J Gastroenterol. 2020; 26(18):2221-2231. PMC: 7235207. DOI: 10.3748/wjg.v26.i18.2221. View

Bossen L, Gines P, Vilstrup H, Watson H, Jepsen P . Serum sodium as a risk factor for hepatic encephalopathy in patients with cirrhosis and ascites. J Gastroenterol Hepatol. 2018; 34(5):914-920. DOI: 10.1111/jgh.14558. View

10.

Bureau C, Thabut D, Jezequel C, Archambeaud I, DAlteroche L, Dharancy S . The Use of Rifaximin in the Prevention of Overt Hepatic Encephalopathy After Transjugular Intrahepatic Portosystemic Shunt : A Randomized Controlled Trial. Ann Intern Med. 2021; 174(5):633-640. DOI: 10.7326/M20-0202. View

11.

Campagna F, Montagnese S, Ridola L, Senzolo M, Schiff S, De Rui M . The animal naming test: An easy tool for the assessment of hepatic encephalopathy. Hepatology. 2017; 66(1):198-208. DOI: 10.1002/hep.29146. View

12.

China L, Tittanegro T, Crocombe D, Forrest E, Kallis Y, Ryder S . Investigating potential confounding by indication when considering the association between proton pump inhibitor use, infection, hepatic encephalopathy and mortality in hospitalised decompensated cirrhosis: a post-hoc analysis of the ATTIRE trial. EClinicalMedicine. 2023; 58:101924. PMC: 10119493. DOI: 10.1016/j.eclinm.2023.101924. View

13.

Dam G, Vilstrup H, Watson H, Jepsen P . Proton pump inhibitors as a risk factor for hepatic encephalopathy and spontaneous bacterial peritonitis in patients with cirrhosis with ascites. Hepatology. 2016; 64(4):1265-72. DOI: 10.1002/hep.28737. View

14.

De Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C . Baveno VII - Renewing consensus in portal hypertension. J Hepatol. 2022; 76(4):959-974. PMC: 11090185. DOI: 10.1016/j.jhep.2021.12.022. View

15.

Gluud L, Dam G, Les I, Marchesini G, Borre M, Aagaard N . Branched-chain amino acids for people with hepatic encephalopathy. Cochrane Database Syst Rev. 2017; 5:CD001939. PMC: 6481897. DOI: 10.1002/14651858.CD001939.pub4. View

16.

Guarner F, Malagelada J . Gut flora in health and disease. Lancet. 2003; 361(9356):512-9. DOI: 10.1016/S0140-6736(03)12489-0. View

17.

Huang C, Yu T, Tseng W, Huang Y, Chang S, Hsieh S . Animal naming test is a simple and valid tool for detecting covert hepatic encephalopathy and predicting outcomes in Chinese-speaking regions: a preliminary study. Ann Med. 2023; 55(1):2236013. PMC: 10373624. DOI: 10.1080/07853890.2023.2236013. View

18.

Jalan R, Kapoor D . Enhanced renal ammonia excretion following volume expansion in patients with well compensated cirrhosis of the liver. Gut. 2003; 52(7):1041-5. PMC: 1773725. DOI: 10.1136/gut.52.7.1041. View

19.

Kanwal F, Neuschwander-Tetri B, Loomba R, Rinella M . Metabolic dysfunction-associated steatotic liver disease: Update and impact of new nomenclature on the American Association for the Study of Liver Diseases practice guidance on nonalcoholic fatty liver disease. Hepatology. 2024; 79(5):1212-1219. DOI: 10.1097/HEP.0000000000000670. View

20.

Laleman W, Simon-Talero M, Maleux G, Perez M, Ameloot K, Soriano G . Embolization of large spontaneous portosystemic shunts for refractory hepatic encephalopathy: a multicenter survey on safety and efficacy. Hepatology. 2013; 57(6):2448-57. DOI: 10.1002/hep.26314. View