Health Tools

The Importance of Screening 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 screened.4

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.5 Patients who have OHE have a 42% probability of survival after 1 year.†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.
This is from a retrospective chart review of medical records from 1990-1993.

LIVERHEALTHNOW supports you as you screen CLD patients for HE, with tools for providers and companion patient and caregiver tools to educate patients through screening and diagnosis of HE.

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Screening Tools 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

Tools 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
  1. Center for Disease Control and Prevention. Chronic liver disease and cirrhosis. Accessed June 21, 2021.
  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. Data on file. Bridgewater, NJ: Salix Pharmaceuticals.
  6. Bustamante J, Rimola A, Ventura P-J, et al. Prognostic significance of hepatic encephalopathy in patients with cirrhosis. J Hepatol. 1999;30(5):890-895.
  7. Patidar KR, Bajaj JS. Covert and overt hepatic encephalopathy: diagnosis and management. Clin Gastroenterol Hepatol. 2015;13(12):2048-2061.