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Hepatic encephalopathy in acute-on-chronic liver failure

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Abstract

The presence of hepatic encephalopathy (HE) within 4 weeks is part of the criteria for defining acute-on-chronic liver failure (ACLF). The pathophysiology of HE is complex, and hyperammonemia and cerebral hemodynamic dysfunction appear to be central in the pathogenesis of encephalopathy. Recent data also suggest that inflammatory mediators may have a significant role in modulating the cerebral effect of ammonia. Multiple prospective and retrospective studies have shown that hepatic encephalopathy in ACLF patients is associated with higher mortality, especially in those with grade III–IV encephalopathy, similar to that of acute liver failure (ALF). Although significant cerebral edema detected by CT in ACLF patients appeared to be less common, specialized MRI imaging was able to detect cerebral edema even in low grade HE. Ammonia-focused therapy constitutes the basis of current therapy, as in the treatment of ALF. Emerging treatment strategies focusing on modulating the gut-liver-circulation-brain axis are discussed.

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Compliance with ethical requirements and Conflict of interest

This article does not contain any studies with human participants or animals performed by any of the authors. Guan-Huei Lee declares that he has no conflict of interest.

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  1. Department of Medicine, National University Health System, 1E, Kent Ridge Road, Singapore, 119228, Singapore

    Guan-Huei Lee

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Lee, GH. Hepatic encephalopathy in acute-on-chronic liver failure. Hepatol Int 9, 520–526 (2015). https://doi.org/10.1007/s12072-015-9626-0

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  • DOI: https://doi.org/10.1007/s12072-015-9626-0

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