Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
Hepatol Int. 2021 Apr;15(2):502-509. doi: 10.1007/s12072-021-10139-0. Epub 2021 Feb 24.
The objectives were to evaluate the role of optic nerve sheath diameter (ONSD) to detect raised intracranial pressure (ICP) in pediatric acute liver failure (PALF), study the variations in ONSD with ICP-lowering measures and to evaluate its prognostic role.
PALF with clinical evidence of raised ICP were enrolled as cases, while those without raised ICP were control group A. ONSD was measured at admission and repeated regularly. It was also measured at time of each new episode of raised ICP and 2 h after the management of such episode.
31 PALF with raised ICP were included as cases and 15 without as control group A. ONSD was significantly higher in cases: 5 mm (IQR: 4.7-5.4) as compared to control group A: 3.8 mm (IQR: 3.3-4). ONSD greater than 4.55 mm at baseline diagnosed clinically raised ICP with 87.5% sensitivity and 100% specificity. The mean ONSD was 5.44 ± 0.49 mm during a total of 90 events of acute raised ICP. Clinical responders had a decrease in ONSD by 0.59 ± 0.24 mm by 2 h, whereas non-responders showed a decrease of 0.18 ± 0.23 mm, p < 0.0005. ONSD persisting more than 4.6 mm by 24 h of management predicted poor outcome with sensitivity and specificity of 83.3% and 72.7%.
ONSD is a simple, bedside, inexpensive, reproducible and repeatable modality to assess ongoing change in ICP in PALF. ONSD more than 4.55 mm suggests raised ICP. The goal should be to bring ONSD down to less than 4.6 mm within 24 h by aggressive anti-ICP therapy to achieve favourable outcome.
本研究旨在评估视神经鞘直径（ONSD）在儿童急性肝衰竭（PALF）中检测颅内压升高（ICP）的作用，研究 ONSD 随 ICP 降低措施的变化，并评估其预后作用。
将有临床证据表明 ICP 升高的 PALF 患者纳入病例组，而无 ICP 升高的患者纳入对照组 A。入院时测量 ONSD，并定期重复测量。在每次 ICP 升高的新发作时以及此类发作管理后 2 小时也进行测量。
纳入 31 例有 ICP 升高的 PALF 患者作为病例组，15 例无 ICP 升高的患者作为对照组 A。病例组的 ONSD 明显更高：5mm（IQR：4.7-5.4），而对照组 A 为 3.8mm（IQR：3.3-4）。基线时 ONSD 大于 4.55mm 可诊断为临床 ICP 升高，具有 87.5%的敏感性和 100%的特异性。在总共 90 次急性 ICP 升高的事件中，平均 ONSD 为 5.44±0.49mm。临床反应者在 2 小时时 ONSD 下降 0.59±0.24mm，而非反应者下降 0.18±0.23mm，p<0.0005。管理后 24 小时 ONSD 持续大于 4.6mm 预测预后不良，敏感性和特异性分别为 83.3%和 72.7%。
ONSD 是一种简单、床边、经济、可重复的方法，可评估 PALF 中 ICP 的持续变化。ONSD 大于 4.55mm 提示 ICP 升高。目标应该是通过积极的抗 ICP 治疗，在 24 小时内将 ONSD 降至 4.6mm 以下，以实现良好的预后。
