1 Division of Gastroenterology and Hepatology, University of Michigan.
2 Gastroenterology Section, VA Ann Arbor Healthcare System, Ann Arbor.
Hepatic encephalopathy (HE) is associated with poor quality of life, sharply increased mortality, repeated hospitalizations, falls, and motor vehicle accidents. HE manifests with a dynamic spectrum of severity. Overt HE is clinically obvious disorientation, even coma. Although multiple strategies are available to characterize early stage HE, data are limited validating these methods in predicting overt HE, many are impractical in clinical practice, and test cutoffs relevant to the average patient clinicians manage are lacking. In order to accurately and efficiently classify the risk of overt HE in the population with cirrhosis, novel strategies may be needed. Herein, we review the potential competing strategies for the prediction of overt HE. We propose refining diagnostic cutoffs for tests designed to define early HE using overt HE as a gold standard and expanding prediction tools by using measures of components from the risk pathway for HE.