SEARCHNARRATIVE_REVIEWgastroenterology, internal medicine

narrative_review·gastroenterology, internal medicine, clinical nutrition·PMC10027066

Prediction and prevention of the first episode of overt hepatic encephalopathy in patients with cirrhosis

Hepatology Communications · 4 authors, 2 centres

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TL;DR

This narrative review evaluates cognitive tests, biomarkers, and imaging markers for predicting a first episode of overt hepatic encephalopathy (OHE) in cirrhosis patients, and finds that cognitive tests such as PHES, CFF, and Stroop EncephalApp are the best validated prediction tools. Despite EASL guideline recommendations for treating covert HE with nonabsorbable disaccharides, the authors conclude that a recommendation for primary prophylaxis of a first OHE episode cannot be made based on current evidence.

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This narrative review by Gairing et al. synthesizes the evidence on prediction and prevention of a first episode of overt hepatic encephalopathy (OHE) in patients with cirrhosis. The authors conclude that a general recommendation for primary prophylaxis of a first OHE episode cannot be made and call for well-designed, double-blinded, randomized controlled trials in well-defined high-risk patients.

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narrative_review

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gastroenterology

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AI pipeline

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ORIGINAL PAPER

PMC10027066

Prediction and prevention of the first episode of overt hepatic encephalopathy in patients with cirrhosis

Hepatology Communications

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ABSTRACT

Hepatic encephalopathy (HE) is one of the most important complications of patients with liver cirrhosis. In addition, HE is associated with a dismal prognosis and has detrimental effects on patients’ quality of life. Thus, it is of pivotal importance to identify patients at high risk for overt HE (OHE) in whom primary prophylaxis may be justified. In this narrative review, we aim to provide insight into predictors and prediction tools for a first-time episode of OHE and to scrutinize the current level of evidence of primary prophylaxis. In recent decades, several cognitive tests, composite scores, and blood-based biomarkers have been demonstrated to be predictive of a first-time episode of OHE. Among the best validated are the established tests for minimal HE, such as the Psychometric Hepatic Encephalopathy Score, determination of the critical flicker frequency, Stroop EncephalApp, or the Animal Naming Test. Individualized risk stratification using blood-based biomarkers and cross-sectional imaging (sarcopenia and spontaneous portosystemic shunts) is coming to the fore, but validation in larger multicenter cohorts is often lacking. On the basis of current evidence, a recommendation for primary prophylaxis of a first episode of OHE cannot be made in general. Only 2 studies have investigated the prevention of a first-time OHE episode as the primary endpoint. In this narrative review, we provide a concise overview of the current evidence levels on prediction tools and pharmacological prevention of a first episode of OHE. In addition, we give an outlook on future research targets to improve knowledge on this important topic.

CITATION EXPORT

Simon J. Gairing, Eva M. Schleicher, Peter R. Galle et al.. Prediction and prevention of the first episode of overt hepatic encephalopathy in patients with cirrhosis. Hepatology Communications. (2023). https://doi.org/10.1097/HC9.0000000000000096

AUTHORS

4 · 2 CENTRES

Simon J. Gairing, Eva M. Schleicher, Peter R. Galle, Christian Labenz

1Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
2Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg-University, Mainz, Germany