Treating hepatic encephalopathy in cirrhotic patients admitted to ICU with sodium phenylbutyrate: a preliminary study

Hepatic encephalopathy ( HE ) influences short‐term and long‐term prognoses. Recently, glycerol phenylbutyrate ( PB ), that lowers ammonia by providing an alternate pathway to urea for waste nitrogen excretion, has shown that it was effective in preventing the occurrence of HE in RCT . The aim was to assess the benefits of sodium PB in cirrhotic patients admitted to ICU for overt HE , in terms of ammonia levels decrease, neurological improvement, and survival. Cirrhotic patients who presented with overt HE , ammonia levels >100 μmol/L, and did not display any contra‐indication were included. Sodium PB was administered at 200 mg/kg/day. Control group included historical controls treated by standard therapy, matched for age, sex, MELD score, and severity of HE . Eighteen patients were included and treated with sodium PB (age: 59 [45–68], male gender: 15 [83%], Child–Pugh B: 8 [44%], Child–Pugh C: 10 [56%], and MELD score: 16 [13–23]). Ammonia levels significantly decreased in the PB as compared to the control group from inclusion to 12 h and from inclusion to 48 h ( P = 0.0201 and P = 0.0230, respectively). The proportion of patients displaying neurological improvement was only higher in the PB ‐treated group as compared to controls at ICU discharge (15 [83%] vs. 9 [50%], P = 0.0339). ICU discharge survival was significantly higher in patients treated with PB (17 [94%] vs. 9 [50%], P = 0.0017). In cirrhotic patients with overt HE , sodium PB could be effective in reducing ammonia levels and might be effective in improving neurological status and ICU discharge survival. More extensive data, especially a RCT , are mandatory.