Characterization of Cerebral Edema in Acute-on-Chronic Liver Failure

Gupta, Tulika; Dhiman, Radha K.; Ahuja, Chirag Kamal; Agrawal, Swastik; Chopra, Madhu; Kalra, Naveen; Duseja, Ajay; Taneja, Sunil; Khandelwal, Niranjan; Chawla, Yogesh

doi:10.1016/j.jceh.2017.04.001

Cited by 18 publications

(19 citation statements)

References 24 publications

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“…The presence of HE itself increases short-term mortality in ACLF as is the severity, i.e., grade of HE [3]. The pathophysiology of HE is complex, and impairment of brain energy and development of brain edema appear to be central in the pathogenesis of encephalopathy [117,118]. Inflammation plays a greater role in the pathogenesis of HE in patients with ACLF than in patients without ACLF and is associated with a cytokine storm.…”

Section: Hepatic Encephalopathymentioning

confidence: 99%

“…Cerebral edema has been observed in ACLF, and even low cerebral edema can be detected by proper CT and MRI. Vasogenic cerebral edema as detected by advanced MRI techniques like magnetization transfer ratio (MTR), diffusion tensor imaging (DTI) and diffusion weighted imaging (DWI) is common, but rarely requires specific treatment [118]. Using advanced MRI techniques, Gupta et al demonstrated presence of cerebral edema increases with severity of ACLF.…”

Section: Hepatic Encephalopathymentioning

confidence: 99%

“…Correlation between mean diffusivity (MD) values and IL-6 levels suggest pathogenic role of inflammation in cerebral edema. MELD score and MD values in frontal white matter have prognostic significance in ACLF [118]. Ammonia, systemic inflammation and oxidative stress are key factors in the pathogenesis of HE, which may be modulated by glutaminase gene alteration or by the presence of spontaneous shunts [118].…”

Section: Hepatic Encephalopathymentioning

confidence: 99%

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Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update

et al. 2019

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The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set up in 2004 on acute-on-chronic liver failure (ACLF) was published in 2009. With international groups volunteering to join, the “APASL ACLF Research Consortium (AARC)” was formed in 2012, which continued to collect prospective ACLF patient data. Based on the prospective data analysis of nearly 1400 patients, the AARC consensus was published in 2014. In the past nearly four-and-a-half years, the AARC database has been enriched to about 5200 cases by major hepatology centers across Asia. The data published during the interim period were carefully analyzed and areas of contention and new developments in the field of ACLF were prioritized in a systematic manner. The AARC database was also approached for answering some of the issues where published data were limited, such as liver failure grading, its impact on the ‘Golden Therapeutic Window’, extrahepatic organ dysfunction and failure, development of sepsis, distinctive features of acute decompensation from ACLF and pediatric ACLF and the issues were analyzed. These initiatives concluded in a two-day meeting in October 2018 at New Delhi with finalization of the new AARC consensus. Only those statements, which were based on evidence using the Grade System and were unanimously recommended, were accepted. Finalized statements were again circulated to all the experts and subsequently presented at the AARC investigators meeting at the AASLD in November 2018. The suggestions from the experts were used to revise and finalize the consensus. After detailed deliberations and data analysis, the original definition of ACLF was found to withstand the test of time and be able to identify a homogenous group of patients presenting with liver failure. New management options including the algorithms for the management of coagulation disorders, renal replacement therapy, sepsis, variceal bleed, antivirals and criteria for liver transplantation for ACLF patients were proposed. The final consensus statements along with the relevant background information and areas requiring future studies are presented here.

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Section: Hepatic Encephalopathymentioning

confidence: 99%

Section: Hepatic Encephalopathymentioning

confidence: 99%

Section: Hepatic Encephalopathymentioning

confidence: 99%

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Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update

et al. 2019

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“…HE in acute liver failure is a distinct type of HE that occurs in the context of severe cytokine storm and brain as well systemic hemodynamic alteration (21,22); thus, it has separate features in which brain swelling and intracranial hypertension have a peculiar role, thus it is a distinct condition with respect of HE occurring in cirrhosis and in non-cirrhotic portal systemic shunts (8). Recently it has been observed that HE in acute on chronic liver failure has some peculiar features (23,24). It frequently occurs in the context of multiorgan failure, sepsis and cytokine storm that reasonably produce overlapping metabolic/haemodynamic encephalopathies that may deserve to be considered separately and frequently require multitarget treatment in ICU managed patients.…”

Section: The Meaning Of the Term Hementioning

confidence: 99%

Lights and Shadows on Hepatic Encephalopathy Diagnosis

Amodio¹,

Montagnese²

2020

Preprint

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Hepatic encephalopathy (HE) is a form of brain dysfunction that is specifically caused by liver insufficiency and/or portal-systemic shunt. The exact nature of HE is debated, so that conflicting uses of the term HE may cause inconsistencies in its detection and, in turn, issues with its management. This review highlights the meaning of the term HE on the basis of both its historical origins and current consensus. It also provides criteria for the diagnosis of the condition, on the basis of its phenotypes and the risk factors for its occurrence. The procedure for differential diagnosis from other conditions which result in similar phenotypes is considered, together with precipitants and confounders. Finally, the current multidimensional approach for the correct clinical recording of HE episodes is discussed.

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“…Recently, it was proposed that a distinction be made between patients with and without acute‐on‐chronic liver failure (ACLF) . The main reason for this is the more severe prognostic value of HE in the context of ACLF, the finding that intercellular brain oedema is parallel with the degree of HE, and, in rare reports, of intracranial hypertension . Cases of ACLF are characterised by greater inflammation than in patients without ACLF, which damages the brain–blood barrier, as well as other injuries to the brain due to multiorgan failure and drug treatments .…”

Section: Diagnosis and Classification Of Hepatic Encephalopathymentioning

confidence: 99%

Hepatic encephalopathy: Diagnosis and management

Amodio

2018

Liver International

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Hepatic encephalopathy (HE) is a peculiar kind of brain dysfunction caused by liver insufficiency and/or portal-systemic shunting. It is related to gut-derived substances. It is a relevant cause of morbidity and hospitalisation for patients with cirrhosis. The prognosis of HE is important in terms of survival and re-hospitalisation. It is related to impaired quality of life, falls and poor driving; presents a relevant burden for caregivers and health services; and may negatively impact on patient's job and income. Proper diagnosis and classification are expected to improve HE management. Once diagnosed, the management and therapeutic options for HE are generally clear. The improvement of knowledge in recent years has also clarified which are the further aims of research in this field of medicine. Prophylaxis of overt HE should always be performed, and this is generally secondary prophylaxis. Primary prophylaxis should be done immediately after upper gastrointestinal bleeding. Great advances in the detection and treatment of mild forms of HE are expected to lead to further improvement in patient management.

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Characterization of Cerebral Edema in Acute-on-Chronic Liver Failure

Cited by 18 publications

References 24 publications

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update

Lights and Shadows on Hepatic Encephalopathy Diagnosis

Hepatic encephalopathy: Diagnosis and management

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