Health Resources

The Importance of Identifying Patients With Chronic Liver Disease for Hepatic Encephalopathy

Chronic liver disease (CLD)

  • Affects about 4.5 million people in the United States1

CLD and cirrhosis are the

  • 6th leading cause of death in persons aged 25-442
  • 5th leading cause of death in persons aged 45-542

Common types of CLD in the United States are increasing:

Prevalence of nonalcoholic fatty liver disease (NAFLD) and resulting nonalcoholic steatohepatitis (NASH) are projected to increase 21% and 63%, respectively, between 2015 and 2030 due to high rates of diabetes and obesity.*3

Incidence of decompensated cirrhosis may increase 168% by 2030, while hepatocellular carcinoma will increase by 137%.*3

As the prevalence of cirrhosis rises, it is expected that cirrhosis complications, including hepatic encephalopathy (HE), will also rise.

The prevalence of minimal HE (MHE) and covert HE (CHE) occurs in as many as 50% of patients with CLD, so guidelines recommend every CLD patient be evaluated.4

After a diagnosis of HE, patients had a 1-year survival rate of 48%.†5

Overt HE (OHE) is estimated to occur in up to 30% to 40% of patients with cirrhosis.4

Screening for CHE is important because it can prognosticate OHE development, indicate poor quality of life, and help identify patients and caregivers who may need to be counseled about the disease.4

In 2018, 37% of hospitalized patients with OHE were readmitted within 30 days.6

HE may affect the patient, the patient’s family, and every one the patient comes in contact with. HE may affect the patient’s ability to work and drive, and has the potential to increase health care costs. It is important to recognize and manage HE to help improve these conditions.7

*These statistics are based on projections, and actual prevalence may differ.
Based on data from 49,000 Medicare enrollees with cirrhosis and continuous Part D (prescription) coverage from 2008-2014.

LIVERHEALTHNOW supports you as you identify CLD patients at risk for HE, with resources for providers and companion patient and caregiver resources.

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Resources for the Provider

  • Assess HE With the Stroop Test
  • West Haven Criteria
  • Diagnosing Hepatic Encephalopathy in Patients With Liver Disease
  • Cirrhosis and Its Complications
  • Understanding Blood-Ammonia Levels in Patients With Hepatic Encephalopathy
  • Coding of Hepatic Encephalopathy
  • AASLD Guidance Checklist for Diagnosing and Monitoring Portal Hypertension

Resources for the Patient

  • What Is Hepatic Encephalopathy?
  • Medication Information for Patients With Hepatic Encephalopathy and Their Caregivers
  • Lifestyle Self-management for Patients With Overt Hepatic Encephalopathy
  • Symptoms, Complications, and Management of Cirrhosis
  • Stages and Types of Liver Disease
  • Know the Signs of Portal Hypertension
  1. Center for Disease Control and Prevention. Chronic liver disease and cirrhosis. Reviewed January 17, 2023. Accessed October 10, 2023.
  2. Heron M. Deaths: leading causes for 2018. Natl Vital Stat Rep. 2021;70(4):1-115. 2021;69(13):1-83.
  3. Estes C, Razavi H, Loomba R, et al. Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease. Hepatology. 2018;67(1):123-133.
  4. Vilstrup H, Amodio P, Bajaj J, et al. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatology. 2014;60(2):715-735.
  5. Tapper EB, Aberasturi D, Zhao Z, et al. Outcomes after hepatic encephalopathy in population-based cohorts of patients with cirrhosis. Aliment Pharmacol Ther. 2020;51(12):1397-1405.
  6. Data on file. Forte 2020. Salix Pharmaceuticals, Bridgewater, NJ.
  7. Patidar KR, Bajaj JS. Covert and overt hepatic encephalopathy: diagnosis and management. Clin Gastroenterol Hepatol. 2015;13(12):2048-2061.