Treatment of Overt Hepatic Encephalopathy in Liver Failure

This protocol applies to patients with liver failure who develop overt hepatic encephalopathy — a clinically significant neurological deterioration driven by hepatic dysfunction that requires targeted intervention.

Clinical Scenario

Liver failure presenting with overt hepatic encephalopathy — a specific and serious complication requiring prompt management to reduce the grade of encephalopathy.

Treatment Goal

Reduction in the grade of hepatic encephalopathy.

Treatment approach (partial overview) Albumin dialysis is among the extracorporeal approaches considered in this setting to ameliorate hepatic encephalopathy — the complete protocol details the specific indications, patient selection, and further management steps.

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References

DOI: 10.1016/j.jhep.2022.06.001

In patients with liver failure and overt HE, albumin dialysis ameliorates HE and can be considered. The impact on prognosis is, however, uncertain and further study is warranted (LoE 2, 77% consensus).
The removal of both water-soluble and lipophilic substances from the blood by albumin dialysis, i.e. the molecular adsorbent recirculating system (MARS) device, has been shown in 3 RCTs and a meta-analysis (on raw data of these trials) to result in a faster reduction in the grade of HE in cirrhosis but with only a modest impact on survival.

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