Grade

Mental state (Shores 2008)

Grade 0

• Abnormality detected

Grade 1

• Trivial lack of awareness

• Euphoria

• Anxiety

• Shortened attention span

• Impairment of addition and subtraction

Grade 2

• Lethargy or apathy

• Disorientation of time

• Obvious personality change

• Inappropriate behavior

Grade 3

• Somnolence to semi stupor

• Responsive to stimuli

• Confused

• Gross disorientation

• Bizarre behavior

Grade 4

• Coma, unable to test mental state

Timing

Prevalence

Incidence

At diagnosis of cirrhosis

10% to 14% in general for overt hepatic encephalopathy

‐

Descompensate cirrhosis

16% to 21% for overt hepatic encephalopathy

‐

Transjugular intrahepatic
portosystemic (TIPS)

10% to 50% for overt hepatic encephalopathy

10% to 50% (median cumulative 1 year for overt hepatic
encephalopathy

At some time during clinical course

and in the survivors in most cases

repeatedly

‐

30% to 40% for overt hepatic encephalopathy

Any patients with cirrhosis

20% to 80% for minimal or covert hepatic encephalopathy

‐

Prehepatic noncirrhotic portal hypertension

Unknown

‐

Within 5 years after cirrhosis diagnosis

‐

5% to 25% in general for overt hepatic encephalopathy

With previous bout of over hepatic

encephalopathy

‐

40% cumulative risk of recurring at 1 year

Another recurrence of over hepatic encephalopathy

‐

40% cumulative risk at 6 months, despite lactulose treatment

Database

Time span

Search strategy

Cochrane Hepato‐Biliary Group Controlled Trials Register

Date will be given at review stage

acetyl‐l‐carnitine or acetyl carnitine or alcar or levacecarnitine) AND (liver cirrhosis or hepatic encephalopathy

Cochrane Central Register of Controlled Trials (CENTRAL)

Latest issue

#1 MeSH descriptor: [Acetylcarnitine] explode all trees

#2 acetyl‐l‐carnitine or acetyl carnitine or alcar or levacecarnitine

#3 #1 or #2

#4 MeSH descriptor: [Hepatic Encephalopathy] explode all trees

#5 MeSH descriptor: [Liver Cirrhosis] explode all trees

#6 liver cirrhosis or hepatic encephalopathy

#7 #4 or #5 or #6

#8 #3 and #7

MEDLINE (Ovid SP)

1946 to the date of search

1. exp Acetylcarnitine/

2. (acetyl‐l‐carnitine or acetyl carnitine or alcar or levacecarnitine).mp. [mp=title, abstract, original title, name of substance word, subject heading word, keyword heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier]

3. 1 or 2

4. exp Hepatic Encephalopathy/

5. exp Liver Cirrhosis/

6. (liver cirrhosis or hepatic encephalopathy).mp. [mp=title, abstract, original title, name of substance word, subject heading word, keyword heading word, protocol supplementary concept, rare disease supplementary concept, unique identifier]

7. 4 or 5 or 6

8. 3 and 7

EMBASE (Ovid SP)

1974 to the date of search

1. exp levacecarnine/

2. (acetyl‐l‐carnitine or acetyl carnitine or alcar or levacecarnitine).mp. [mp=title, abstract, subject headings, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword]

3. 1 or 2

4. exp hepatic encephalopathy/

5. exp liver cirrhosis/

6. (liver cirrhosis or hepatic encephalopathy).mp. [mp=title, abstract, subject headings, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword]

7. 4 or 5 or 6

8. 3 and 7

Science Citation Index Expanded

1900 to the date of search

#3 #2 AND #1

#2 TS=(liver cirrhosis or hepatic encephalopathy)

#1 TS=(acetyl‐l‐carnitine or acetyl carnitine or alcar or levacecarnitine)

LILACS

1982 to the date of search

#3 #2 AND #1

#2 (liver cirrhosis or hepatic encephalopathy)

#1 (acetyl‐l‐carnitine or acetyl carnitine or alcar or levacecarnitine)