Hepatic encephalopathy in acute-on-chronic liver failure
- 28 May 2015
- journal article
- review article
- Published by Springer Science and Business Media LLC in Hepatology International
- Vol. 9 (4), 520-526
- https://doi.org/10.1007/s12072-015-9626-0
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.Keywords
This publication has 53 references indexed in Scilit:
- Characteristics, risk factors, and mortality of cirrhotic patients hospitalized for hepatic encephalopathy with and without acute-on-chronic liver failure (ACLF)Journal of Hepatology, 2014
- Modulation of the Metabiome by Rifaximin in Patients with Cirrhosis and Minimal Hepatic EncephalopathyPLOS ONE, 2013
- Prediction of the prognosis of patients with acute‐on‐chronic hepatitis B liver failure using the model for end‐stage liver disease scoring system and a novel logistic regression modelJournal of Viral Hepatitis, 2009
- Intestinal decontamination improves liver haemodynamics in patients with alcohol‐related decompensated cirrhosisAlimentary Pharmacology & Therapeutics, 2009
- Cerebral diffusion tensor imaging and in vivo proton magnetic resonance spectroscopy in patients with fulminant hepatic failureJournal of Gastroenterology and Hepatology, 2008
- Magnetic resonance analysis of the effects of acute ammonia intoxication on rat brain. Role of NMDA receptorsJournal of Neurochemistry, 2007
- Pathogenesis of intracranial hypertension in acute liver failure: inflammation, ammonia and cerebral blood flowJournal of Hepatology, 2004
- Comparison of rifaximin and lactitol in the treatment of acute hepatic encephalopathy: results of a randomized, double-blind, double-dummy, controlled clinical trialJournal of Hepatology, 2003
- Manganese deposition in basal ganglia structures results from both portal-systemic shunting and liver dysfunctionGastroenterology, 1999
- Cerebral oedema and increased intracranial pressure in chronic liver diseaseThe Lancet, 1998