How do you approach identifying the dominant, actionable drivers of symptom burden (HE vs infection, renal dysfunction, malignancy-related symptoms, etc.) in decompensated cirrhosis patients with frequent hospitalizations or very limited prognosis, and does that change how aggressively you pursue HE-directed therapy versus other symptom pathways?

In decompensated cirrhosis with very limited prognosis and uncertain HE contribution to symptoms, what is your default HE treatment strategy?

• Standard HE-directed escalation without a predefined trial duration
• Time-limited escalation trial, continued only with symptom benefit
• Maintain existing therapy without escalation
• Reduce or stop therapy to limit treatment burden
• Other