{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T00:21:46Z","timestamp":1760746906571,"version":"build-2065373602"},"reference-count":19,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T00:00:00Z","timestamp":1760659200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Hepatic encephalopathy (HE) is a severe neuropsychiatric complication of advanced liver disease, driven primarily by ammonia accumulation due to impaired hepatic detoxification and portosystemic shunting. Lactulose is a cornerstone therapy, while rifaximin serves as an effective adjunct for reducing recurrence and hospitalizations. Methods: We conducted a retrospective cohort study at Constan\u021ba Emergency County Hospital from January 2022 to March 2025, including 120 adult patients diagnosed with HE. Inclusion criteria were confirmed diagnosis of cirrhosis with clinical and\/or biochemical evidence of HE. Patients with other primary neurological disorders or incomplete medical records were excluded. Data on demographics, comorbidities, laboratory results, and medications were collected. Statistical analyses were performed employing descriptive statistics, Friedman\u2019s two-way ANOVA by ranks for medication use, and Cox proportional hazards regression to assess survival associations. Results: The mean age was 61.19 years, with high prevalence of anemia (mean hemoglobin: 9.35 g\/dL) and thrombocytopenia (mean: 121.86 \u00d7 103\/\u00b5L). Inflammatory markers were elevated (mean CRP: 36.95 mg\/L; ESR: 55.83 mm\/h), and INR averaged 1.86. Lactulose was administered to 63.3% of patients, rifaximin to 52.5%, with diuretics, pantoprazole, and albumin being frequently used. Friedman\u2019s analysis ranked lactulose highest in usage frequency. Cox regression indicated no significant short-term survival difference associated with toxic encephalopathy or rifaximin use. Conclusion: In this cohort, lactulose remained the primary treatment for HE, often complemented by supportive pharmacotherapy. While rifaximin use was limited, the overall medication patterns reflected standard practice priorities in HE management.<\/jats:p>","DOI":"10.3390\/jcm14207331","type":"journal-article","created":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T11:39:34Z","timestamp":1760701174000},"page":"7331","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Lactulose, Rifaximin, and Survival in Hepatic Encephalopathy: A Cohort Study of 120 Patients"],"prefix":"10.3390","volume":"14","author":[{"given":"Luana","family":"Alexandrescu","sequence":"first","affiliation":[{"name":"Gastroenterology Department, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania"},{"name":"Medicine Faculty, \u201cOvidius\u201d University of Constanta, 1 Universitatii Street, 900470 Constanta, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ionut Tiberiu","family":"Tofolean","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania"},{"name":"Medicine Faculty, \u201cOvidius\u201d University of Constanta, 1 Universitatii Street, 900470 Constanta, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina","family":"Aftenie","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daria Maria","family":"Alexandrescu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Titu Maiorescu University, 040051 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4057-348X","authenticated-orcid":false,"given":"Doina Ecaterina","family":"Tofolean","sequence":"additional","affiliation":[{"name":"Medicine Faculty, \u201cOvidius\u201d University of Constanta, 1 Universitatii Street, 900470 Constanta, Romania"},{"name":"Pneumology Department, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6702-7086","authenticated-orcid":false,"given":"Alina Doina","family":"Nicoara","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2132-0911","authenticated-orcid":false,"given":"Alina Mihaela","family":"Stanigut","sequence":"additional","affiliation":[{"name":"Medicine Faculty, \u201cOvidius\u201d University of Constanta, 1 Universitatii Street, 900470 Constanta, Romania"},{"name":"Nephrology Department, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5872-4381","authenticated-orcid":false,"given":"Andreea","family":"Nelson Twakor","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena","family":"Rusu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Titu Maiorescu University, 040051 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7268-3723","authenticated-orcid":false,"given":"Eugen","family":"Dumitru","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania"},{"name":"Medicine Faculty, \u201cOvidius\u201d University of Constanta, 1 Universitatii Street, 900470 Constanta, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9550-3537","authenticated-orcid":false,"given":"Andrei","family":"Dumitru","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania"},{"name":"Medicine Faculty, \u201cOvidius\u201d University of Constanta, 1 Universitatii Street, 900470 Constanta, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina","family":"Tocia","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania"},{"name":"Medicine Faculty, \u201cOvidius\u201d University of Constanta, 1 Universitatii Street, 900470 Constanta, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra","family":"Herlo","sequence":"additional","affiliation":[{"name":"Department XIII, Discipline of Infectious Diseases, \u201cVictor Babes\u201d University of Medicine and Pharmacy Timisoara, 2 Eftimie Murgu Square, 300041 Timisoara, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miruna Alexa","family":"Mihu","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ioana","family":"Popescu","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elena","family":"Dina","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bogdan","family":"Cimpineanu","sequence":"additional","affiliation":[{"name":"Medicine Faculty, \u201cOvidius\u201d University of Constanta, 1 Universitatii Street, 900470 Constanta, Romania"},{"name":"Nephrology Department, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 145 Tomis Blvd., 900591 Constanta, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,17]]},"reference":[{"key":"ref_1","first-page":"e86193","article-title":"Therapeutic Duel of Rifaximin Versus Lactulose in Hepatic Encephalopathy: A Systematic Review","volume":"17","author":"Oriko","year":"2025","journal-title":"Cureus"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1097\/MEG.0000000000002595","article-title":"Management of minimal and overt hepatic encephalopathy with branched-chain amino acids: A review of the evidence","volume":"35","author":"Swansson","year":"2023","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1194","DOI":"10.1002\/hep.32255","article-title":"L-ornithine L-aspartate in acute treatment of severe hepatic encephalopathy: A double-blind randomized controlled trial","volume":"75","author":"Jain","year":"2022","journal-title":"Hepatology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e0295","DOI":"10.1097\/HC9.0000000000000295","article-title":"Lactulose in cirrhosis: Current understanding of efficacy, mechanism, and practical considerations","volume":"7","author":"Bloom","year":"2023","journal-title":"Hepatol. Commun."},{"key":"ref_5","unstructured":"BioRender.com (2025, August 11). Scientific Image and Illustration Software. Available online: https:\/\/www.biorender.com\/."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1660","DOI":"10.1002\/hep.31708","article-title":"The use of rifaximin in patients with cirrhosis","volume":"74","author":"Caraceni","year":"2021","journal-title":"Hepatology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2147\/DDDT.S172324","article-title":"Combination of rifaximin and lactulose improves clinical efficacy and mortality in patients with hepatic encephalopathy","volume":"13","author":"Wang","year":"2018","journal-title":"Drug Des. Devel. Ther."},{"key":"ref_8","unstructured":"American Association for the Study of Liver Diseases (AASLD) (2025, August 06). Why Do We Use Lactulose and Rifaximin for Hepatic Encephalopathy? Liver Fellow Network. Available online: https:\/\/www.aasld.org\/liver-fellow-network\/core-series\/why-series\/why-do-we-use-lactulose-and-rifaximin-hepatic."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1330","DOI":"10.1016\/j.amjmed.2021.06.007","article-title":"Overt hepatic encephalopathy: Current pharmacologic treatments and improving clinical outcomes","volume":"134","author":"Rahimi","year":"2021","journal-title":"Am. J. Med."},{"key":"ref_10","unstructured":"Cochrane (2025, September 02). Rifaximin for Prevention and Treatment of Hepatic Encephalopathy in People with Cirrhosis. Cochrane. Available online: https:\/\/www.cochrane.org\/evidence\/CD011585_rifaximin-prevention-and-treatment-hepatic-encephalopathy-people-cirrhosis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1007\/s40265-018-1018-z","article-title":"Hepatic encephalopathy: Definition, clinical grading and diagnostic principles","volume":"79","author":"Weissenborn","year":"2019","journal-title":"Drugs"},{"key":"ref_12","first-page":"126666","article-title":"Sample size and Shapiro-Wilk test: An analysis for soybean grain yield","volume":"142","author":"Toebe","year":"2022","journal-title":"Eur. J. Agron."},{"key":"ref_13","unstructured":"McClenaghan, E., and McClenaghan, E. (2025, August 12). The Friedman Test. Available online: https:\/\/www.technologynetworks.com\/tn\/articles\/the-friedman-test-387454."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1038\/sj.bjc.6601119","article-title":"Survival analysis part II: Multivariate data analysis\u2014An introduction to concepts and methods","volume":"89","author":"Bradburn","year":"2003","journal-title":"Br. J. Cancer"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Fu, J., Gao, Y., and Shi, L. (2022). Combination therapy with rifaximin and lactulose in hepatic encephalopathy: A systematic review and meta-analysis. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0267647"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2100","DOI":"10.1016\/j.cgh.2023.03.019","article-title":"Update in the Treatment of the Complications of Cirrhosis","volume":"21","author":"Abraldes","year":"2023","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"goae072","DOI":"10.1093\/gastro\/goae072","article-title":"Advances in the management of complications from cirrhosis","volume":"12","author":"Singh","year":"2024","journal-title":"Gastroenterol. Rep."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1994","DOI":"10.1007\/s10620-021-07075-2","article-title":"Hepatic Encephalopathy-Related Hospitalizations in Cirrhosis: Transition of Care and Closing the Revolving Door","volume":"67","author":"Frenette","year":"2022","journal-title":"Dig. Dis. Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e35266","DOI":"10.1097\/MD.0000000000035266","article-title":"Primary prevention of hepatic encephalopathy post-TIPS: A systematic review and meta-analysis","volume":"102","author":"Liang","year":"2023","journal-title":"Medicine"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/20\/7331\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T12:18:58Z","timestamp":1760703538000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/20\/7331"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,17]]},"references-count":19,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["jcm14207331"],"URL":"https:\/\/doi.org\/10.3390\/jcm14207331","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,17]]}}}