Details

Autor(en) / Beteiligte

• Kitzberger, Reinhard
• Funk, Georg Christian
• Holzinger, Ulrike
• Miehsler, Wolfgang
• Kramer, Ludwig
• Kaider, Alexandra
• Ferenci, Peter
• Madl, Christian

Titel

Severity of Organ Failure Is an Independent Predictor of Intracranial Hypertension in Acute Liver Failure

Ist Teil von

• Clinical gastroenterology and hepatology, 2009-09, Vol.7 (9), p.1000-1006

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2009

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• Background & Aims Ionized ammonia (NH3 ) and partial pressure of the gaseous ammonia (pNH3 ) are associated with hepatic encephalopathy and intracranial hypertension in patients with acute liver failure; NH3 is also believed to contribute to extrahepatic organ failure. We investigated whether the severity of organ failure was associated with intracranial hypertension and evaluated the correlation between NH3 and pNH3 and grade of hepatic encephalopathy. Methods In 87 patients with acute liver failure admitted to the intensive care unit, we simultaneously evaluated arterial ammonia, pNH3 , clinical grade of hepatic encephalopathy, the sequential organ failure assessment score (SOFA score), and evidence of intracranial hypertension. Results In comparing patients with intracranial hypertension (n = 37) with patients without intracranial hypertension (n = 50), the highest NH3 and pNH3 levels and SOFA scores before onset of intracranial hypertension were independent predictors of intracranial hypertension ( P < .001). Among patients with NH3 levels less than 146 μmol/L, those with intracranial hypertension had a higher SOFA score than those without intracranial hypertension (median, 10 vs 5.5; P = .004), despite the patients' similar levels of NH3 . NH3 ( r = 0.68, P < .0001) and pNH3 ( r = 0.78, P < .0001) both correlated with grade of hepatic encephalopathy. However, in multiple regression analysis, only pNH3 ( P < .0001) was shown to be a significant independent parameter for predicting grade of hepatic encephalopathy ( P = .27). Conclusions SOFA score and ammonia levels are independent predictors of intracranial hypertension. In patients with acute liver failure admitted to the intensive care unit, pNH3 level is a better predictor of clinical grade of hepatic encephalopathy than arterial NH3 level.