Hepatic Encephalopathy in Acute-on-Chronic Liver Failure

Inclusion of HE across all society definitions of ACLF is a sign of the importance of acute encephalopathy in the syndrome. Acute encephalopathy in ACLF occurs in the setting of massive inflammation, and reversible causes should be investigated. HE not only is associated with increased mortality in ACLF but often also interferes or delays evaluation for liver transplant, as the patient will be either too unstable or unable to participate in the evaluation. Given its impact on survival and increased hospital resource utilization, more work is needed to appropriately identify those who are at risk of developing brain failure during admission with better prognostication tools. Additionally, research efforts should include novel treatments for acute encephalopathy in the setting of ACLF. Research into medical therapy managing the encephalopathic patient with ACLF should also identify optimal ICU care such as ventilator management, sedation, and vasopressor support. When transplant is not feasible or futility has been reached, better implementation of palliative care services, including liver-centric palliative care providers, may result in shorter hospital stays, resource utilization, and patient satisfaction.

Automated summary

The inclusion of acute encephalopathy in all society definitions of acute-on-chronic liver failure (ACLF) highlights its significance in the syndrome. Acute encephalopathy in ACLF is caused by severe inflammation, and it is important to identify reversible causes. Hepatic encephalopathy not only increases mortality in ACLF but also hinders evaluation for liver transplant due to patient instability. Further research is needed to identify at-risk individuals, develop better prognostic tools, and explore novel treatments. Optimal ICU care, palliative care services, and patient satisfaction should be considered in managing encephalopathic patients.