Prognosis

Although some forms of this condition are reversible, overall, the development of overt HE portends a poor prognosis. In one retrospective study of 111 cirrhotic patients, an episode of overt HE was associated with 42% 1-year survival and 23% 3-year survival.[54] For patients at grade 4 (coma) when encephalopathy develops, mortality has been reported as 80%. A second retrospective study of 494 patients with end-stage liver disease noted that an episode of overt HE was associated with as much as a 3.9-fold increased risk of death (P <0.01).[55] Even after an episode of overt HE resolves, residual cognitive impairment can be detected.[56]

An episode of HE has a significant impact on a patient's employment and finances. Patients who have had an episode of HE are less likely to be working, are more likely to decrease their hours of work, and feel worse off financially than patients who have cirrhosis but have not had HE.[57] HE places a significant burden on carers, who report a significant impact on their own health and schedule and a sense of entrapment.[57]

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