Liver cirrhosis

Epidemiology of hepatic encephalopathy in cirrhosis

There are around 786 million cirrhosis patients worldwide, around 30-70% with latent HE and around 50% with impaired driving ability. The 5 year probability of survival is 16-22% in cirrhosis patients with HE, and 55-70% in cirrhosis patients without HE.1

Cirrhosis is the common end-stage of chronic liver diseases. It usually develops from progressive fatty liver and creates irreversible damage including development of fibrous scar tissue that replaces healthy liver tissue. The clinical course of cirrhosis is generally chronic progressive and can lead to portal hypertension and disturbances of normal liver functions. This, in turn, can lead to decreased detoxification of ammonia in the liver as a result of (a) loss of vital hepatic parenchyma: synthesis of urea and glutamine is reduced and (b) collateral circulation due to portal hypertension leads to increased concentrations of ammonia in the blood.1

The multiple causes of liver cirrhosis

The many complications of cirrhosis include ascites, bleeding from oesophageal or abdominal varices, jaundice, clotting disorders, renal failure and hepatic encephalopathy (HE). Around 40% of patients with cirrhosis will dettoriate and develop HE.1

Suggested reading

  • Dan L. Longo 2012 – Harrison’s principles of internal medicine. (18th ed.). New York: McGraw-Hill. pp. Chapter 308. Cirrhosis and Its Complications.
  • Poordad FF. Review article: the burden of hepatic encephalopathy. Aliment Pharmacol Ther. 2007;25 Suppl 1:3-9.
  • Starr SP, Raines D. Cirrhosis: diagnosis, management, and prevention. Am Fam Physician. 2011;84(12):1353-9.
  • García-Martínez R, et al. Prognostic assessment in patients with hepatic encephalopathy. Dis Markers. 2011;31(3):171-9.
  • Albilllos A, Garcia-Tsao G. Classification of cirrhosis: the clinical use of HVPG measurements. Dis Markers. 2011;31(3):121-8.
  • Moriwaki H, et al. Hepatic encephalopathy as a complication of liver cirrhosis: an Asian perspective. J Gastroenterol Hepatol. 2010;25(5):858-63.
  • Jang JW. Current status of liver diseases in Korea: liver cirrhosis. Korean J  Hepatol. 2009;15 Suppl 6:S40-9.
  • Björnsson E. The natural history of drug-induced liver injury. Semin Liver Dis. 2009;29(4):357-63.


1. Dan L. Longo 2012 – Harrison’s principles of internal medicine. (18th ed. ed.). New York: McGraw-Hill. pp. Chapter 308. Cirrhosis and Its Complications.