Ammonia Lowering Therapy for Hyperammonemic ACLF Without Overt HE

This study focuses on patients with acute-on-chronic liver failure (ACLF) who have high ammonia levels in their blood but do not show obvious signs of hepatic encephalopathy (HE), a brain condition caused by liver disease. The trial aims to find out if specific treatments to lower ammonia levels, using medications like lactulose and rifaximin, can reduce severe liver-related complications such as severe liver failure, infections, worsening of brain function, or death. These outcomes are evaluated over three time points: day 7, day 28, and day 90 after starting the treatment. This research is important because it may offer a way to improve the health and survival of patients with this severe liver condition. In this study, participants are randomly divided into groups to receive either the ammonia-lowering treatment or standard medical treatment. The study is conducted openly, meaning both the doctors and participants know which treatments are being given. The effectiveness and safety of the treatments are closely monitored by checking for any major liver-related complications. The study takes place at a single medical center, and results are expected to guide better treatment strategies for managing high ammonia levels in patients with ACLF without apparent HE symptoms.