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6 kwi 2018 · Hepatic encephalopathy is a marker of poor survival 9, 77 and is related to poor QoL. However, its role in ranking patients for liver transplantation priority is difficult, since it is not considered in the model for end-stage liver disease (MELD) score.
2 mar 2020 · Risk factors for a poor prognosis include acid-base and electrolyte disturbances, diminished renal function, biochemical evidence of poor hepatic synthetic function, and acute-on-chronic liver failure.
17 cze 2022 · In patients with hepatic myelopathy, liver transplantation should be considered as soon as possible since there is no other therapeutic option (LoE 4, strong recommendation). 94%: In patients with cirrhosis-related Parkinsonism, dopaminergic treatment should be tested (LoE 2, strong recommendation). 95%
Prognosis of these patients is poor; unless there is access to liver transplantation, 1-year survival generally does not exceed 40% 6, 7. Also, minimal HE (mHE) is associated with a significant impact on quality of life and an increased risk of development of overt HE, hospital admission, and death.
In a retrospective chart review of 213 cases, Mantry and colleagues showed that the number of hospitalizations and the duration of hospital stays were shortened for patients receiving combination therapy compared with those receiving lactulose monotherapy.
Treatment of acute overt hepatic encephalopathy should include (1) supportive care, (2) identification and treatment of precipitating factors, (3) reduction of nitrogenous load in the gut, and (4) assessment of need for long-term therapy and liver transplant evaluation.
Prognosis of hepatic encephalopathy is guarded, in spite of improvement in intensive medical support. One-year survival is 40%, and 3-year survival is 15%. Fulminant hepatic failure has a mortality rate of 75%, and severe hepatic coma carries a substantial risk of permanent neurologic disability.
