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Review
. 2018 Sep;8(3):286-293.
doi: 10.1016/j.jceh.2018.06.002. Epub 2018 Jun 20.

Cerebral Blood Flow and Metabolism in Hepatic Encephalopathy-A Meta-Analysis

Peter N Bjerring  1   2 , Lise L Gluud  2 , Fin S Larsen  1
Affiliations
Review

Cerebral Blood Flow and Metabolism in Hepatic Encephalopathy-A Meta-Analysis

Peter N Bjerring et al. J Clin Exp Hepatol. 2018 Sep.

Abstract

Hepatic Encephalopathy (HE) is associated with abnormalities in brain metabolism of glucose, oxygen and amino acids. In patients with acute liver failure, cortical lactate to pyruvate ratio is increased, which is indicative of a compromised cerebral oxidative metabolism. In this meta-analysis we have reviewed the published data on cerebral blood flow and metabolic rates from clinical studies of patients with HE. We found that hepatic encephalopathy was associated with reduced cerebral metabolic rate of oxygen, glucose, and blood flow. One exemption was in HE type B (shunt/by-pass) were a tendency towards increased cerebral blood flow was seen. We speculate that HE is associated with a disturbed metabolism-cytopathic hypoxia-and that type specific differences of brain metabolism is due to differences in pathogenesis of HE.

Keywords: ALF, Acute Liver Failure; CBF, Cerebral Blood Flow; CMR, Cerebral Metabolic Rate; HE, Hepatic Encephalopathy; ICH, Intracranial Hypertension; MHE, Minimal Hepatic Encephalopathy; MRI, Magnetic Resonance Imaging; OHE, Overt Hepatic Encephalopathy; PCS, Portocaval Shunt; cerebral blood flow; cerebral metabolism; hepatic encephalopathy; liver failure; pcMRI, Phase-Contrast MRI.

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Figures

Figure 1
Figure 1
Random-effects meta-analysis of studies with estimates of standardized mean differences (SMD). Insert: funnel plot. ALF: Acute Liver Failure; Minimal HE: Minimal Hepatic Encephalopathy; OHE: Overt Hepatic Encephalopathy; PCS: Portocaval Shunt; TIPS: Transjugular Intrahepatic Portosystemic Shunt.
Figure 2
Figure 2
Random-effects subgroup analysis based on the modality of cerebral blood flow measurement (A) and aetiology of hepatic encephalopathy (B).
Figure 3
Figure 3
Random-effects meta-analysis of cerebral metabolic rates of oxygen (A) and glucose (B).
See this image and copyright information in PMC

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