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In patients with cirrhosis, the main risk factors for developing overt HE include MHE, sarcopenia, hyponatremia, epilepsy, type 2 diabetes, elevated creatinine, elevated bilirubin, and hypoalbuminemia.1 Because overt HE is a manifestation of decompensated liver failure, it has a negative impact on survival

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However, research indicates that S-nitrosation, tyrosine nitration, and damage to FeS centers may play a role (Pappas et al., 2023

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Harris ML, Schiller HJ, Reilly PM, Donowitz M, Grisham MB, and Bulkey GB (1992)

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