Ampuero J, et al. - Given that in all patients, the complete efficacy of current therapies for hepatic encephalopathy (HE) is not observed, probably due to the physiopathological heterogeneity and the different conditions underlying the bout of HE, researchers examined if the risk of HE could be predicted using oral glutamine challenge (OGC) through the identification of various features and types of HE. They assessed 238 cirrhotic patients (198 without and 40 with a previous HE episode) that underwent OGC, obtaining baseline and 60 min postload ammonia levels. During the follow-up, HE developed in 28.3% (56/198) of the main cohort. Low-, intermediate- and high-risk groups were defined using a combined evaluation of baseline hyperammonemia (> 78 mcg/dL) and impaired OGC (Δ > 32 mcg/dL). In the competing risk analysis, they identified the first HE episode to be correlated with both intermediate- (subhazard ratio (sHR) 2.01 (95% CI 1.00-4.14)) and high-risk groups (sHR 4.67 (95% CI 2.19-9.98), together with age and albumin. For repeated HE events, similar results were identified. Findings thereby support the value of OGC in recognizing patients at risk of HE and further, it defined specific features of the episodes. This indicates the utility of this tool in the decision-making process for the adequate management of HE.