Infection, inflammation and hepatic encephalopathy from a clinical perspective

Area of Science:

• Hepatology
• Neurology
• Gastroenterology

Background:

• Hepatic encephalopathy (HE) is a neuropsychiatric syndrome linked to acute and chronic liver damage.
• Ammonia's role in brain edema is established in acute liver failure, while infection and inflammation are key in severe HE.
• In cirrhosis, the interplay of ammonia, inflammation, and infection drives HE progression, with gut microbiome disruptions implicated.

Purpose of the Study:

• To review the clinical perspective on inflammation and infection in hepatic encephalopathy.
• To present evidence for current and developing therapies for HE in acute and chronic liver failure.

Main Methods:

• Literature review of clinical studies and therapeutic evidence.
• Synthesis of current understanding of HE pathogenesis.
• Analysis of the role of gut microbiome and inflammation in HE.

Main Results:

• Infection and inflammation are critical factors in severe HE, contributing to cerebral edema and intracranial hypertension.
• Gut microbiome perturbations and impaired gut barrier function promote systemic inflammation, impacting HE.
• Lactulose and rifaximin efficacy may stem from modulating the gut microbiome and reducing inflammation.

Conclusions:

• Inflammation and infection are central to the pathogenesis and progression of hepatic encephalopathy.
• Targeting the gut microbiome and associated inflammation represents a key therapeutic strategy for HE in liver failure.