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Factors such as poor diet, chronic stress, environmental toxins, and certain medical conditions can further deplete glutathione levels

MPO activity, used as an indicator of PMN cell infiltration [38,39,40]

The disorder is characterized by seven biochemically distinct alterations, all resulting in the increase in concentrations of homocystine and methionine in body fluids (Table 1)

Quality of evidence: II-B, Strength of recommendation: 1 Panel level of agreement: In total agreement 96%, in partial agreement 4% The WHC have traditionally been used for diagnosing and grading the severity of clinically overt HE, but they are a subjective tool, with limited interobserver reliability, especially for a grade I classification

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