Circulatory, Respiratory, Cerebral, and Renal Derangements in Acute Liver Failure: Pathophysiology and Management

Ellis, Angela E.; Wendon, Julia

doi:10.1055/s-2007-1007251

Cited by 152 publications

(130 citation statements)

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“…22 Intracranial hypertension is defined as intracranial pressure greater than 25 mm Hg (monitored in 4 patients) or clinical signs of this condition (decerebrate posturing, abnormal pupillary reflexes). 23 Pulmonary failure is defined as the need for mechanical ventilation and an inspired oxygen fraction greater than 0.40, 23 excluding the first 12 hours after intubation and the terminal 12 hours before death. 10,24 Infection is defined as the detection of pathogenic microbial species in blood or tracheal cultures.…”

Section: Patientsmentioning

confidence: 99%

Temporal profile of total, bound, and free Gc-globulin after acetaminophen overdose

Schiødt¹,

Ott²,

Tygstrup³

et al. 2001

Liver Transplantation

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Low admission values of the actin scavenger Gc-globulin are associated with an adverse outcome in acetaminophen (paracetamol) overdose. This prospective longitudinal study including 84 patients with acetaminophen overdose characterizes the temporal profile of Gc-globulin during the entire length of hospitalization. Serum Gc-globulin (total, actin bound, and free) levels and actin-complex ratio were measured on admission and every 12 hours until discharge. In 32 patients without hepatotoxicity (non-HEPTOX group; peak transaminase levels < 1,000 U/L), total and free Gc-globulin levels and complex ratio remained within normal range during hospitalization. Among 52 patients with hepatotoxicity (HEPTOX group; peak transaminase levels > 1,000 U/L), 15 patients had hepatic encephalopathy (HE), and 37 patients did not. In these 2 groups, total and free Gc-globulin levels decreased to 97 and 50 mg/L and 148 and 86 mg/L, respectively (normal mean, 340 and 299 mg/L), the nadir occurring at 72 hours postoverdose. Complex ratio peaked at 60 hours at levels more than 3-fold greater than normal. Conversely, bound Gc-globulin remained within normal levels for all patients throughout the observation period. At day 2, a total Gc-globulin cutoff value of less than 120 mg/L correctly predicted HE in 75%, and a value greater than 120 mg/L correctly predicted the absence of HE in 91% of patients. In conclusion, Gc-globulin is severely stressed in patients with hepatotoxicity. Extreme values occurred at 60 to 72 hours postoverdose, a period in which Gc-globulin protection against actin toxicity may be inadequate. A total Gc-globulin level less than 120 mg/L on day 2 is a good predictor of later HE. Bound Gc-globulin is maintained at constant levels independent of total Gc-globulin levels, suggesting a balanced upregulation of the removal of bound Gc-globulin even under conditions with increased actin release. (Liver Transpl 2001;7:732-738.)

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Section: Patientsmentioning

confidence: 99%

Temporal profile of total, bound, and free Gc-globulin after acetaminophen overdose

Schiødt¹,

Ott²,

Tygstrup³

et al. 2001

Liver Transplantation

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“…111,112 In part, this is caused by the rapid development of cerebral edema and multiorgan failure within days to weeks of clinical presentation. 103,113 Many of these patients receive marginal or even blood type group A, group B, group O-incompatible organs because of the extremely narrow window of time in which transplantation can be performed. Nevertheless, this is the only viable therapeutic option for many patients with this rapidly fatal condition.…”

Section: Fhfmentioning

confidence: 99%

Liver transplantation

Carithers

2000

Liver Transpl

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Liver transplantation has revolutionized the care of patients with end-stage liver disease. Liver transplantation is indicated for acute or chronic liver failure from any cause. Because there are no randomized controlled trials of liver transplantation versus no therapy, the efficacy of this surgery is best assessed by carefully comparing postoperative survival with the known natural history of the disease in question. The best examples of this are in primary biliary cirrhosis and primary sclerosing cholangitis, for which well-validated disease-specific models of natural history are available. There are currently relatively few absolute contraindications to liver transplantation. These include severe cardiopulmonary disease, uncontrolled systemic infection, extrahepatic malignancy, severe psychiatric or neurological disorders, and absence of a viable splanchnic venous inflow system. One of the most frequently encountered contraindications to transplantation is ongoing destructive behavior caused by drug and alcohol addiction. The timing of the surgery can have a profound impact on the mortality and morbidity of patients undergoing liver transplantation. Because of the long waiting lists for donor organs, the need to project far in advance when transplantation might be required has proven to be one of the greatest challenges to those treating patients with end-stage liver disease. Three important questions must be addressed in a patient being considered for liver transplantation: (1) when should the patient be referred for possible transplantation? (2) when should the patient be listed for transplantation? and (3) when is the patient too sick to have a reasonable chance of surviving the perioperative period?

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“…Patients suffering from acute liver failure (ALF) develop a hyperdynamic circulation (1). Although the occurrence of arterial hypotension is widely recognized (2), the exact pathogenesis has still to be defined.…”

Section: Introductionmentioning

confidence: 99%

Contractile response of femoral arteries in pigs with acute liver failure

Ytrebø

Ekse

Sen

et al. 2004

Scandinavian Journal of Gastroenterology

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Background: Acute liver failure (ALF) is characterized haemodynamically by a progressive hyperdynamic circulation. The pathophysiological mechanism is unknown, but impaired contractility of vascular smooth muscle may play an important role. The aim of this study was to evaluate the vascular response to stimulation with norepinephrine and angiotensin II in endothelium-denuded femoral artery rings. Methods: Norwegian Landrace pigs weighing 27.1 ± 0.5 kg (mean ± s x (standard error of the mean)) were used. ALF was induced by performing a portacaval shunt followed by ligation of the hepatic arteries (n = 6). Sham-operated animals served as controls (n = 5). Cumulative isometric concentration contraction curves were obtained after in vitro stimulation of the femoral artery rings with either angiotensin II (10 −13 -10 −5 mol/L) or norepinephrine (10 −13 -10 −3 mol/L). Results: Pigs suffering from ALF developed a hyperdynamic circulation with an increased cardiac index (P = 0.017) and decreased systemic vascular resistance index (P = 0.015). Studies of the hind leg revealed a decreased vascular resistance index and increased blood flow compared to sham-operated controls (P = 0.003 and P = 0.01, respectively). Angiotensin II caused a concentration-dependent contraction of the arterial segments, with no significant differences in vascular responses between the two groups. Maximum force generated did not differ (55 ± 7 versus 56 ± 7 mN, P = 0.95). Furthermore, there were no differences for norepinephrine in the cumulative concentration-response curves and the maximum contractile force was not significantly different (87 ± 8 versus 93 ± 16 mN, P = 0.55). Conclusions: This study documents for the first time that there are no signs of endothelium-independent peripheral vascular hyporesponsiveness to angiotensin II and norepinephrine in pigs with ALF.

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Circulatory, Respiratory, Cerebral, and Renal Derangements in Acute Liver Failure: Pathophysiology and Management

Cited by 152 publications

References 0 publications

Temporal profile of total, bound, and free Gc-globulin after acetaminophen overdose

Temporal profile of total, bound, and free Gc-globulin after acetaminophen overdose

Liver transplantation

Contractile response of femoral arteries in pigs with acute liver failure

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