Multicenter Study

. 2025 Apr 15;7(4):e1251.

doi: 10.1097/CCE.0000000000001251. eCollection 2025 Apr 1.

Brain CT Scan Diagnostic and Prognostic Value in Patients With Acute Liver Failure and Cerebral Edema: A Multicenter Cohort Study

Filipe S Cardoso^{1

2}, William M Lee³, Constantine J Karvellas²; U.S. Acute Liver Failure Study Group

Collaborators, Affiliations

Collaborators

U.S. Acute Liver Failure Study Group:
W M Lee⁴, Anne M Larson⁴, Iris Liou⁴, Oren Fix⁵, Michael Schilsky⁶, Timothy McCashland⁷, J Eileen Hay⁸, Natalie Murray⁹, A Obaid S Shaikh¹⁰, Andres Blei¹¹, Daniel Ganger¹¹, Atif Zaman¹², Steven H B Han¹³, Robert Fontana¹⁴, Brendan McGuire¹⁵, Raymond T Chung¹⁶, Alastair Smith¹⁷, Robert Brown¹⁸, Jeffrey Crippin¹⁹, Adrian Reuben²⁰, Santiago Munoz²¹, Rajender Reddy²², R Todd Stravitz²³, Lorenzo Rossaro²⁴, Raj Satyanarayana²⁵, Tarek Hassanein²⁶, Constantine J Karvellas²⁷, Jodi Olson²⁸, Ram Subramanian²⁹, James Hanje³⁰, Bilal Hameed³¹, Grace Samuel³², Ezmina Lalani³², Carla Pezzia³², Corron Sanders³², Nahid Attar³², Linda S Hynan³², Valerie Durkalski, Wenle Zhao, Jaime Speiser, Catherine Dillon, Holly Battenhouse, Michelle Gottfried

Affiliations

¹ Intensive Care Unit, Transplant Unit, Curry Cabral Hospital, Nova Medical School, Lisbon, Portugal.
² Department of Critical Care Medicine and Liver Unit, University of Alberta, Edmonton, AB, Canada.
³ Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, TX.
⁴ University of Washington, Seattle, WA.
⁵ Swedish Medical Center, Seattle, WA.
⁶ Yale University, New Haven, CT.
⁷ University of Nebraska, Omaha, NE.
⁸ Mayo Clinic, Rochester, MN.
⁹ Baylor University Medical Center, Dallas, TX.
¹⁰ University of Pittsburgh, Pittsburgh, PA.
¹¹ Northwestern University, Chicago, IL.
¹² University of Oregon, Portland, OR.
¹³ University of California, Los Angeles, CA.
¹⁴ University of Michigan, Ann Arbor, MI.
¹⁵ University of Alabama, Birmingham, AL.
¹⁶ Massachusetts General Hospital, Boston, MA.
¹⁷ Duke University Medical Center, Durham, NC.
¹⁸ Cornell/Columbia University, New York, NY.
¹⁹ Washington University, St Louis, MO; Edwin Harrison, Mayo Clinic, Scottsdale, AZ.
²⁰ Medical University of South Carolina, Charleston, SC.
²¹ Albert Einstein Medical Center, Philadelphia, PA.
²² University of Pennsylvania, Philadelphia, PA.
²³ Virginia Commonwealth University, Richmond, VA.
²⁴ University of California Davis, Sacramento, CA.
²⁵ Mayo Clinic, Jacksonville, FL.
²⁶ University of California, San Diego, CA.
²⁷ University of Alberta, Edmonton, AB.
²⁸ University of Kansas, Kansas City, KA.
²⁹ Emory, Atlanta, GA.
³⁰ Ohio State University, Columbus,OH.
³¹ University of California San Francisco, CA.
³² the Medical University of South Carolina Data Coordination Unit included.

PMID: 40232229
PMCID: PMC12002376
DOI: 10.1097/CCE.0000000000001251

Multicenter Study

Brain CT Scan Diagnostic and Prognostic Value in Patients With Acute Liver Failure and Cerebral Edema: A Multicenter Cohort Study

Filipe S Cardoso et al. Crit Care Explor. 2025.

. 2025 Apr 15;7(4):e1251.

doi: 10.1097/CCE.0000000000001251. eCollection 2025 Apr 1.

Authors

Filipe S Cardoso^{1

2}, William M Lee³, Constantine J Karvellas²; U.S. Acute Liver Failure Study Group

Collaborators

U.S. Acute Liver Failure Study Group:
W M Lee⁴, Anne M Larson⁴, Iris Liou⁴, Oren Fix⁵, Michael Schilsky⁶, Timothy McCashland⁷, J Eileen Hay⁸, Natalie Murray⁹, A Obaid S Shaikh¹⁰, Andres Blei¹¹, Daniel Ganger¹¹, Atif Zaman¹², Steven H B Han¹³, Robert Fontana¹⁴, Brendan McGuire¹⁵, Raymond T Chung¹⁶, Alastair Smith¹⁷, Robert Brown¹⁸, Jeffrey Crippin¹⁹, Adrian Reuben²⁰, Santiago Munoz²¹, Rajender Reddy²², R Todd Stravitz²³, Lorenzo Rossaro²⁴, Raj Satyanarayana²⁵, Tarek Hassanein²⁶, Constantine J Karvellas²⁷, Jodi Olson²⁸, Ram Subramanian²⁹, James Hanje³⁰, Bilal Hameed³¹, Grace Samuel³², Ezmina Lalani³², Carla Pezzia³², Corron Sanders³², Nahid Attar³², Linda S Hynan³², Valerie Durkalski, Wenle Zhao, Jaime Speiser, Catherine Dillon, Holly Battenhouse, Michelle Gottfried

Affiliations

¹ Intensive Care Unit, Transplant Unit, Curry Cabral Hospital, Nova Medical School, Lisbon, Portugal.
² Department of Critical Care Medicine and Liver Unit, University of Alberta, Edmonton, AB, Canada.
³ Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, Dallas, TX.
⁴ University of Washington, Seattle, WA.
⁵ Swedish Medical Center, Seattle, WA.
⁶ Yale University, New Haven, CT.
⁷ University of Nebraska, Omaha, NE.
⁸ Mayo Clinic, Rochester, MN.
⁹ Baylor University Medical Center, Dallas, TX.
¹⁰ University of Pittsburgh, Pittsburgh, PA.
¹¹ Northwestern University, Chicago, IL.
¹² University of Oregon, Portland, OR.
¹³ University of California, Los Angeles, CA.
¹⁴ University of Michigan, Ann Arbor, MI.
¹⁵ University of Alabama, Birmingham, AL.
¹⁶ Massachusetts General Hospital, Boston, MA.
¹⁷ Duke University Medical Center, Durham, NC.
¹⁸ Cornell/Columbia University, New York, NY.
¹⁹ Washington University, St Louis, MO; Edwin Harrison, Mayo Clinic, Scottsdale, AZ.
²⁰ Medical University of South Carolina, Charleston, SC.
²¹ Albert Einstein Medical Center, Philadelphia, PA.
²² University of Pennsylvania, Philadelphia, PA.
²³ Virginia Commonwealth University, Richmond, VA.
²⁴ University of California Davis, Sacramento, CA.
²⁵ Mayo Clinic, Jacksonville, FL.
²⁶ University of California, San Diego, CA.
²⁷ University of Alberta, Edmonton, AB.
²⁸ University of Kansas, Kansas City, KA.
²⁹ Emory, Atlanta, GA.
³⁰ Ohio State University, Columbus,OH.
³¹ University of California San Francisco, CA.
³² the Medical University of South Carolina Data Coordination Unit included.

PMID: 40232229
PMCID: PMC12002376
DOI: 10.1097/CCE.0000000000001251

Abstract

Objective: 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.

Design: International multicenter retrospective cohort.

Setting: U.S. Acute Liver Failure Study Group prospective registry.

Patients: Consecutive patients with ALF within the registry from January 1998 to August 2016.

Interventions: The primary exposure was cerebral edema on CT scan. The primary endpoint was 21-day post-inclusion transplant-free survival (TFS).

Measurements and main results: 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).

Conclusions: 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.

Keywords: cerebral edema; death; intracranial hypertension; liver failure; transplant.

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Conflict of interest statement

The authors have disclosed that they do not have any potential conflicts of interest.

References

1. Reddy KR, Ellerbe C, Schilsky M, et al. ; Acute Liver Failure Study Group: Determinants of outcome among patients with acute liver failure listed for liver transplantation in the United States. Liver Transpl 2016; 22:505–515 - PMC - PubMed
1. Ostapowicz G, Fontana RJ, Schiødt FV, 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; 137:947–954 - PubMed
1. Stravitz RT, Lee WM: Acute liver failure. Lancet 2019; 394:869–881 - PMC - PubMed
1. Bernal W, Hyyrylainen A, Gera A, et al. : Lessons from look-back in acute liver failure? A single centre experience of 3300 patients. J Hepatol 2013; 59:74–80 - PubMed
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Brain CT Scan Diagnostic and Prognostic Value in Patients With Acute Liver Failure and Cerebral Edema: A Multicenter Cohort Study

Collaborators

Affiliations

Brain CT Scan Diagnostic and Prognostic Value in Patients With Acute Liver Failure and Cerebral Edema: A Multicenter Cohort Study

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical