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

Background and Aims The nature of cerebral edema in acute-on-chronic liver failure (ACLF) is not well studied. We aimed to characterize cerebral edema in ACLF using magnetization transfer ratio (MTR) and diffusion tensor imaging (DTI). Methods Forty-six patients with cirrhosis and acute decompensati...

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Published in:Journal of clinical and experimental hepatology 2017-09, Vol.7 (3), p.190-197
Main Authors: Gupta, Tarana, Dhiman, Radha K, Ahuja, Chirag K, Agrawal, Swastik, Chopra, Madhu, Kalra, Naveen, Duseja, Ajay, Taneja, Sunil, Khandelwal, Niranjan, Chawla, Yogesh
Format: Article
Language:English
Subjects:
acute-on-chronic liver failure
cerebral edema
diffusion tensor imaging
Endocrinology & Metabolism
Gastroenterology and Hepatology
magnetic resonance imaging
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Summary:Background and Aims The nature of cerebral edema in acute-on-chronic liver failure (ACLF) is not well studied. We aimed to characterize cerebral edema in ACLF using magnetization transfer ratio (MTR) and diffusion tensor imaging (DTI). Methods Forty-six patients with cirrhosis and acute decompensation were included. Patients were divided into groups A (no cerebral failure, n = 39) and B (cerebral failure, n = 7). Group A was subdivided into no-ACLF ( n = 11), grade 1 ( n = 10), grade 2 ( n = 9) and grade 3 ( n = 9) ACLF as per CANONIC study. MRI brain and plasma TNF-alpha, IL-1beta and IL-6 were measured at baseline and 7–10 days after admission. Ten age- and sex-matched healthy controls were also included. Results Mean diffusivity (MD) values, an MRI marker of water content, progressively increased from controls to no-ACLF to ACLF grade 1, 2 and 3 in group A in frontal white matter (FWM) and basal ganglia ( P < 0.0001). MD values improved only in survivors on follow-up. MD values correlated with IL-6 levels at baseline. On multivariate analysis MELD score ≥28 and MD values (>8 × 10−9 M2 /s) in FWM were independent predictors of 90-day mortality. There was no significant difference in clinical and MRI parameters between group A and B. Conclusion Cerebral edema increases with severity of ACLF. Correlation between MD values and IL-6 levels suggests pathogenic role of inflammation in cerebral edema. Patients with grade 3 ACLF have cerebral edema irrespective of presence of clinically evident cerebral failure. MELD score and cerebral edema have prognostic significance in ACLF.
ISSN:0973-6883
2213-3453
DOI:10.1016/j.jceh.2017.04.001