Cardoso Filipe S, Lee William M, Karvellas Constantine J
Intensive Care Unit, Transplant Unit, Curry Cabral Hospital, Nova Medical School, Lisbon, Portugal.
Department of Critical Care Medicine and Liver Unit, University of Alberta, Edmonton, AB, Canada.
Crit Care Explor. 2025 Apr 15;7(4):e1251. doi: 10.1097/CCE.0000000000001251. eCollection 2025 Apr 1.
Patients with acute liver failure (ALF) may develop cerebral edema. We aimed to study the CT scan diagnostic and prognostic value among patients with ALF and cerebral edema.
International multicenter retrospective cohort.
U.S. Acute Liver Failure Study Group prospective registry.
Consecutive patients with ALF within the registry from January 1998 to August 2016.
The primary exposure was cerebral edema on CT scan. The primary endpoint was 21-day post-inclusion transplant-free survival (TFS).
Among 2108 patients with ALF, 243 (11.5%) had a brain CT scan. Among those 243 patients, 105 (43.2%) had cerebral edema and 11 (4.5%) later developed tonsillar herniation. Patients with cerebral edema on CT scan were younger (36 vs. 46 yr; p < 0.001) and more often females (81.0% vs. 63.8%; p = 0.003), had more acetaminophen-related ALF (61.0% vs. 39.4%; p < 0.001), required more frequently invasive mechanical ventilation on day 1 (73.3% vs. 55.8%; p = 0.005), and had higher maximum days 1-7 model for end-stage liver disease (MELD) score (39 vs. 35; p = 0.002) than others. Following adjustment for confounders (age, acetaminophen toxicity, and severity of disease by MELD), cerebral edema was associated with lower odds of 21-day TFS (adjusted odds ratio = 0.36 [95% CI, 0.18-0.72]; C-statistic = 0.81 [95% CI, 0.75-0.86]; p = 0.003). However, cerebral edema was not associated with selection for liver transplant (22.9% vs. 16.1%; p = 0.18).
In our cohort of patients with ALF, brain CT scan use increased overtime. Among those with a brain CT scan, about two in five had cerebral edema. Cerebral edema on CT scan was independently associated with worse 21-day TFS but did not preclude transplant. Brain CT scan may provide additional diagnostic and prognostic information in selected patients with ALF.
急性肝衰竭（ALF）患者可能会出现脑水肿。我们旨在研究CT扫描在ALF合并脑水肿患者中的诊断及预后价值。
国际多中心回顾性队列研究。
美国急性肝衰竭研究组前瞻性注册研究。
1998年1月至2016年8月注册研究中连续入选的ALF患者。
主要暴露因素为CT扫描显示的脑水肿。主要终点为入组后21天无移植生存（TFS）。
在2108例ALF患者中，243例（11.5%）进行了脑部CT扫描。在这243例患者中，105例（43.2%）有脑水肿，11例（4.5%）后来出现了小脑扁桃体疝。CT扫描显示有脑水肿的患者更年轻（36岁对46岁；p<0.001），女性比例更高（81.0%对63.8%；p = 0.003），对乙酰氨基酚相关性ALF更多（61.0%对39.4%；p<0.001），第1天更频繁需要有创机械通气（73.3%对55.8%；p = 0.005），且第1 - 7天终末期肝病模型（MELD）评分更高（39对35；p = 0.002）。在对混杂因素（年龄、对乙酰氨基酚毒性及MELD评估的疾病严重程度）进行校正后，脑水肿与21天TFS的较低几率相关（校正比值比 = 0.36 [95%CI，0.18 - 0.72]；C统计量 = 0.81 [95%CI，0.75 - 0.86]；p = 0.003）。然而，脑水肿与肝移植的选择无关（22.9%对16.1%；p = 0.18）。
在我们的ALF患者队列中，脑部CT扫描的使用随时间增加。在进行脑部CT扫描的患者中，约五分之二有脑水肿。CT扫描显示的脑水肿与较差的21天TFS独立相关，但并不排除移植。脑部CT扫描可能为部分ALF患者提供额外的诊断和预后信息。
