Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Apr;28(3):170-178.
doi: 10.1159/000511646. Epub 2020 Dec 2.

Optic Nerve Sheath Diameter in Acute Liver Failure: A Prospective Cohort Study

Filipe S Cardoso  1 , Rui Pereira  1 , Rui Moreno  2 , Constantine J Karvellas  3 , Nuno Germano  1
Affiliations

Optic Nerve Sheath Diameter in Acute Liver Failure: A Prospective Cohort Study

Filipe S Cardoso et al. GE Port J Gastroenterol. 2021 Apr.

Abstract
in English, Portuguese

Introduction: Acute liver failure (ALF) is a rare disease that may lead to cerebral edema and death. An increased optic nerve sheath diameter (ONSD) may reflect an early increase in intracranial pressure. We assessed the feasibility and safety of the ONSD measurement and its association with outcomes in patients with ALF.

Methods: This was an open-label prospective cohort study including adult patients with ALF admitted to a liver-specialized intensive care unit (ICU) in an academic center between October 2018 and February 2020 (among 24): 20 as intention-to-treat and 17 as per-protocol analyses. The ONSD measurement (primary exposure) used an ultrasound transducer (3 determinations on each eye per patient). The primary outcome was hospital mortality.

Results: Among the 20 patients, 11 (55.0%) were females and the mean age was 45 ± 16 years. On the day of ONSD measurement (median 32.4 h post-ICU admission; IQR 19.8-59.8): 8 patients (40.0%) were in a coma, the mean international normalized ratio (INR) was 3.3 ± 1.4, median bilirubin was 12.3 mg/dL (IQR 4.7-24.5), mean ammonia was 163 ± 101 µmol/L, and mean SOFA score was 11 ± 5. The mean bilateral ONSD was 5.6 ± 0.7 mm, with a very good correlation between right and left eyes (Pearson's r = 0.90). Ten (50.0%) patients were transplanted and 13 (65.0%) patients survived the hospital stay (all with a 2-month extended Glasgow Outcome Scale of 8). The mean ONSD was significantly higher for hospital non-survivors than survivors both in the intention-to-treat (6.2 vs. 5.3 mm; p = 0.004) and per-protocol (6.2 vs. 5.2 mm; p = 0.004) analyses. No adverse effects from ONSD measurements were reported.

Conclusions: In patients with ALF, a higher ONSD was associated with higher hospital mortality. ONSD measurement is feasible and safe and may have prognostic value.

Introdução: A falência hepatica aguda (ALF) é uma doença rara que pode complicar com edema cerebral e morte. O aumento do diâmetro da bainha do nervo óptico (ONSD) pode reflectir um aumento precose da pressão intracraniana. Avaliámos a viabilidade e segurança da medição do ONSD e a sua associação com os resultados de doentes com ALF.

Métodos: Coorte prospectivo aberto incluindo doentes adultos com ALF admitidos numa unidade de cuidados intensivos (ICU) especializada em fígado entre 10/2018 e 02/2020 (em 24): 20 como análise intenção-de-tratar e 17 como análise por-protocolo. A medição do ONSD (exposição primária) foi realizada com um transdutor ultra-sónico (3 medições em cada olho por doente). O resultado primário foi a mortalidade hospitalar.

Resultados: Entre 20 doentes, 11 (55.0%) eram mulheres e a idade média (SD) foi 45 (16) anos. No dia da medição do ONSD (mediana (IQR) de 32.4 (19.8–59.8) horas pós admissão na ICU): coma em 8 (40.0%) doentes, INR médio (SD) de 3.3 (1.4), bilirrubina mediana (IQR) de 12.3 (4.7–24.5) mg/dL, amónia média (SD) de 163 (101) μmol/L, e SOFA médio (SD) de 11 (5). O ONSD bilateral médio (SD) foi de 5.6 (0.7) mm, com boa correlação entre os olhos (Pearson r = 0.90). Dez (50.0%) doentes foram transplantados e 13 (65.0%) sobreviveram à hospitalização (todos com escala de Glasgow Outcome aos 2 meses de 8). O ONSD médio foi significativamente maior nos não-sobreviventes do que nos sobreviventes quer na análise intenção-de-tratar (6.2 mm vs. 5.3 mm; p = 0.004) quer na análise por-protocolo (6.2 mm vs. 5.2 mm; p = 0.004). Não se registaram efeitos adversos.

Conclusões: Em doentes com ALF, maior ONSD esteve associado com maior mortalidade hospitalar. A medição do ONSD é viável, segura, e poderá ter valor prognóstico.

Keywords: Cerebral edema; Liver failure; Optic nerve.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Flowchart of patients with ALF included and excluded from the study.
Fig. 2
Fig. 2
ONSD measurement.
Fig. 3
Fig. 3
Mean bilateral ONSD stratified by HE grade.
See this image and copyright information in PMC

References

    1. Wendon J, Cordoba J, Dhawan A, Larsen FS, Manns M, Samuel D, et al. EASL Governing Board representative EASL Clinical Practical Guidelines on the management of acute (fulminant) liver failure. J Hepatol. 2017 May;66((5)):1047–81. - PubMed
    1. Polson J, Lee WM, American Association for the Study of Liver Disease AASLD position paper: the management of acute liver failure. Hepatology. 2005 May;41((5)):1179–97. - PubMed
    1. Acharya SK, Batra Y, Hazari S, Choudhury V, Panda SK, Dattagupta S. Etiopathogenesis of acute hepatic failure: eastern versus Western countries. J Gastroenterol Hepatol. 2002 Dec;17((s3 Suppl 3)):S268–73. - PubMed
    1. Bernal W, Wendon J. Acute liver failure. N Engl J Med. 2013 Dec;369((26)):2525–34. - PubMed
    1. Ostapowicz G, Fontana RJ, Schiødt FV, Larson A, Davern TJ, Han SH, et al. U.S. Acute Liver Failure Study Group Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med. 2002 Dec;137((12)):947–54. - PubMed