ORCID (Optional)


Document Type

Original Report


Digestive System Diseases | Gastroenterology | Hepatology


Background: Hepatic encephalopathy (HE) is a devastating complication of cirrhosis that increases mortality. Many patients do not receive guideline recommended HE treatment.

Our aim is to evaluate trends in HE treatment over time, variables associated with receiving treatment, and outcomes based on the type of treatment received.

Methods: Retrospective single-center cohort study of hospitalized patients with HE from July 2012 – June 2022. HE treatment was defined as receiving lactulose, rifaximin, or combination therapy.

Results: A total of 1,683 unique patients were included, 72% of patients received HE treatment. Fewer HE patients received any treatment in 2022 (65.9%) compared to 2012 (72%). Predictors of receiving any treatment included: Medicare use (p = 0.02), increasing MELD-Na score (p < 0.0001), having portal hypertension (p < 0.0001), hepatocellular carcinoma (p = 0.03), alcohol-related cirrhosis (p < 0.0001), and being seen by gastroenterology/ hepatology (p = 0.003) or internal medicine (p < 0.0001). Predictors of receiving combination therapy included: having alcohol- related (p = 0.002), biliary (p = 0.01), or other cirrhosis (p < 0.0001), and portal hypertension (p = 0.04). Any HE treatment was associated with higher 30-day readmission (p < 0.0001) and 1-year mortality (p = 0.0005). Combination therapy was associated with a longer median length of stay (7.8 vs. 6.6 days, p = 0.01).

Conclusion: HE treatment rates decreased from 2012 to 2022, especially among patients of older age, with autoimmune cirrhosis, lower MELD-Na scores, and infection while hospitalized. Increasing access to care from gastroenterology/hepatology is a modifiable factor that may increase HE treatment.




hepatic encephalopathy, rifaximin, lactulose, cirrhosis, hospitalization, mortality, readmission

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.



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