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Factors Associated With Progression, Resolution and Mortality of Patients With Overt Hepatic Encephalopathy
Maria P Ballester1,2, Anindro Bhattacharya3, Ferran Aguilar4
1Digestive Disease Department, Hospital Clínico Universitario de Valencia, Spain.
Journal of Clinical and Experimental Hepatology
|December 24, 2025
Summary
Overt hepatic encephalopathy (OHE) progression is linked to higher mortality, especially with acute-on-chronic liver failure (ACLF). However, resolving OHE offers a similar prognosis to patients without OHE, highlighting the importance of understanding its natural history.
Area of Science:
- Hepatology
- Gastroenterology
- Internal Medicine
Background:
- Overt hepatic encephalopathy (OHE) is a reversible cirrhosis complication leading to hospitalization.
- Factors influencing OHE progression, resolution, and mortality, especially with acute-on-chronic liver failure (ACLF), remain unclear.
Purpose of the Study:
- To investigate factors associated with the progression, resolution, and mortality of overt hepatic encephalopathy in patients with cirrhosis.
Main Methods:
- Prospective cohort study (PREDICT) of 1273 hospitalized cirrhosis patients.
- Evaluation of OHE progression, severity changes, and resolution at 1 week.
- Statistical analyses included Cox regression, interaction analyses, and Kaplan-Meier curves.
Main Results:
- Older age, metabolic dysfunction-associated steatotic liver disease, prior lactulose treatment, ACLF, and admission albumin/WBC counts were linked to OHE.
- OHE progression (3%) associated with older age, prior lactulose, and bacterial infections, significantly increasing mortality risk.
- OHE resolution (79%) showed a similar prognosis to patients without OHE.
Conclusions:
- ACLF presence and OHE progression correlate with high short-term mortality.
- OHE resolution indicates a significantly better prognosis.
- Understanding OHE's natural history is crucial for developing new therapeutic strategies.
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