Affiliations: Servei de Medicina Interna-Hepatologia. Hospital Vall
d'Hebron, Departament de Medicina, Universitat Autónoma de Barcelona,
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas
y Digestivas (CIBEREHD), Spain
Note: [] Address for correspondence: Juan Córdoba, Servei de Medicina
Interna-Hepatologia. Hospital Vall d'Hebron. Paseo Vall d'Hebron 119,
Barcelona, 08035, Spain. E-mail: jcordoba@vhebron.net
Abstract: Hepatic encephalopathy (HE) is a common complication of liver
failure that is associated with poor prognosis. However, the prognosis is not
uniform and depends on the underlying liver disease. Acute liver failure is an
uncommon cause of HE that carries bad prognosis but is potentially reversible.
There are several prognostic systems that have been specifically developed for
selecting patients for liver transplantation. In patients with cirrhosis the
prognosis of the episode of HE is usually dictated by the underlying
precipitating factor. Acute-on-chronic liver failure is the most severe form of
decompensation of cirrhosis, the prognosis depends on the number of associated
organ failures. Patients with cirrhosis that have experienced an episode of HE
should be considered candidates for liver transplant. The selection depends on
the underlying liver function assessed by the Model for End-stage Liver Disease
(MELD) index. There is a subgroup that exhibits low MELD and recurrent HE,
usually due to the coexistence of large portosystemic shunts. The recurrence of
HE is more common in patients that develop progressive deterioration of liver
function and hyponatremia. The bouts of HE may cause sequels that have been
shown to persist after liver transplant.
