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Those results were confirmed in an independent patient cohort.34 Lastly, focusing on ammonemia, while monitoring the therapeutic response, could be a way to improve results in patients with HE.32 And so, even though for the time being routine ammonia determination cannot be recommended, we agree with other expert groups that future research should concentrate on developing a standardized focus for the collection and processing of serum ammonia and the interpretation of its results.33 10 The psychometric hepatic encephalopathy score (PHES) is considered accessible, sensitive, and cost-effective for the diagnosis of MHE, in addition to being standardized

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