Cerebral oedema is rare in acute‐on‐chronic liver failure patients presenting with high‐grade hepatic encephalopathy. (12th July 2013)

• Record Type: Journal Article
• Authors: Joshi, Deepak; O'Grady, John; Patel, Amit; Shawcross, Debbie; Connor, Steven; Deasy, Neil; Willars, Chris; Bernal, William; Wendon, Julia; Auzinger, Georg
• Is Part Of: Liver international. Volume 34:Number 3(2014:Apr.)
• Page Start: 362
• Page End: 366
• Publication Date: 2013-07-12
• Subjects: Liver -- Periodicals; Liver -- Diseases -- Periodicals; 616.362
• DOI: 10.1111/liv.12257
• Languages: English
• ISSNs: 1478-3223

Abstract

<abstract abstract-type="main" id="liv12257-abs-0001"> <title>Abstract</title> <sec id="liv12257-sec-0001" sec-type="section"> <title>Background & Aims</title> <p>Acute‐on‐chronic liver failure (ACLF) has a rapidly progressive disease course associated with significant mortality. The prevalence of clinically significant cerebral oedema in ACLF is unknown.</p> </sec> <sec id="liv12257-sec-0002" sec-type="section"> <title>Methods</title> <p>We aimed to describe the prevalence of cerebral oedema in a cohort of ACLF adult (>18 years). We identified patients admitted to a single, specialist intensive care unit between January 2005 and January 2011 with high‐grade hepatic encephalopathy (≥3) and a clinical picture of either ACLF or chronic liver disease (CLD). Patients who had undergone cranial CT imaging were identified and their imaging reviewed. The ACLF and CLD groups were compared.</p> </sec> <sec id="liv12257-sec-0003" sec-type="section"> <title>Results</title> <p>One thousand and eight patients with CLD were admitted. One hundred and seventy‐three patients (110 male) underwent neuroimaging. Eighty‐one (48 male) fulfilled criteria for ACLF. Variceal bleeding (30%) and sepsis (31%) were the most frequent precipitants of ACLF. Of those with neuroimaging from the total cohort, 30% of CT scans were normal, 30% demonstrated increased cerebral atrophy for age, 17% small vessel disease and 16% intracranial haemorrhage (ICH). Cerebral oedema was seen in three patients with ACLF only. An increased prevalence of ICH was observed in the ACLF group (23% vs. 9%, <italic>P</italic> = 0.008).</p> </sec> <sec id="liv12257-sec-0004" sec-type="section"> <title>Conclusion</title> <p>The prevalence of clinically relevant cerebral oedema was low (4%) but fatal. Death was attributable to tonsillar herniation. An increased prevalence of ICH was seen in ACLF patients and remains an important differential.</p> </sec> </abstract>