Management der hepatischen Enzephalopathie bei Patienten mit akut-auf-chronischem Leberversagen

Hepatic encephalopathy (HE) is one of the most serious complications of liver cirrhosis. Analyses of German hospital data have shown an increasing incidence of HE in recent years. Brain failure in patients with acute-on-chronic liver failure (ACLF) is defined by the presence of grade 3 or 4 HE and is associated with a poor prognosis. The cornerstones of the pathophysiology of HE in ACLF are hyperammonemia and, above all, pronounced systemic inflammation. In addition to its prognostic relevance, HE is a debilitating experience for both patients and their relatives, and significantly impairs quality of life. Nevertheless, the significance of HE is still often underestimated in clinical practice and treatment is not always performed consistently. In order to improve the prognosis of the disease and minimize its impact on everyday life, adequate diagnosis as well as targeted and rapid treatment are of utmost importance. This article provides an overview of the epidemiology, pathophysiology, diagnosis, and management of HE in patients with ACLF.