Contrast‐Enhanced Ultrasonography–Based Hepatic Perfusion for Early Prediction of Prognosis in Acute Liver Failure

Kuroda, Hidekatsu; Abe, Tamami; Fujiwara, Yoshitaka; Nagasawa, Takayuki; Suzuki, Yuji; Kakisaka, Keisuke; Takikawa, Yasuhiro

doi:10.1002/hep.31615

Cited by 18 publications

(9 citation statements)

References 50 publications

(103 reference statements)

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“…Solís-Muñoz et al reported that the portal vein velocity was significantly lower in acutely decompensated patients with cirrhosis who developed ACLF than in those who did not develop ACLF ( 46 ). Furthermore, our data are in line with the results of Kuroda et al ( 34 ) who analyzed hepatic perfusion using contrast-enhanced ultrasound (CEUS) in patients with acute liver failure (ALF) and investigated its utility as a prognostic tool ( 47 ). The authors recorded the time interval (TI) between the time to peak of the hepatic artery (HA) and liver parenchyma (LP) by performing CEUS at baseline and after 7 days.…”

Section: Discussionsupporting

confidence: 89%

Hepatic perfusion as a new predictor of prognosis and mortality in critical care patients with acute-on-chronic liver failure

et al. 2022

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Background and aimsLiver diseases are frequent causes of morbidity and mortality worldwide. Liver diseases can lead to cirrhosis, with the risk of acute-on-chronic liver failure (ACLF). For the detection of changes in hepatic hemodynamics, Doppler ultrasonography is a well-established method. We investigated hepatic hemodynamics via serial Doppler ultrasonography to determine the predictive value of changes in hepatic perfusion for the outcome in patients with severe liver diseases compared to established prognostic models such as the MELD (Model for End-Stage Liver Disease) or CLIF-C (Chronic Liver Failure-Consortium) ACLF score.MethodsIn this prospective cohort study, hepatic perfusion was quantified at baseline before the initiation of treatment and every third day by means of serial measurements of the hepatic artery resistance index (HARI) and the maximum portal vein velocity (PVv) using Doppler ultrasonography in 50 consecutive patients with severe liver diseases admitted to a medical intensive care unit (MICU). The recorded hemodynamic parameters were compared to the MELD score, and the CLIF-C ACLF score to analyze their utility for the prediction of the outcome of patients with severe liver diseases, liver cirrhosis, and ACLF.ResultsThe changes (delta) obtained by serial measurements of the MELD score, HARI, and PVv were analyzed through scatter plots. Bivariate correlation analysis yielded a new positive linear correlation between the delta-HARI and the delta-MELD score (r = 0.469; p < 0.001). In addition, our data revealed a new negative linear correlation between delta-PVv and the delta-MELD score (r = −0.279, p = 0.001). The leading cause of MICU mortality was acute-on-chronic liver failure (ACLF). A subgroup analysis of patients with liver cirrhosis revealed a positive linear correlation between the delta-HARI and the delta-CLIF-C-ACLF score (r = 0.252, p = 0.005). Of clinical relevance, non-survivors of ACLF exhibited a significantly higher mean value for the delta-HARI (0.010 vs. −0.005; p = 0.015) and a lower mean value for the delta-PVv (−0.7 vs. 1.9 cm/s; p = 0.037) in comparison to survivors of ACLF.ConclusionThis study shows the prognostic value of the assessment of hepatic perfusion in critical care patients with severe liver diseases by bedside Doppler ultrasound examination and its utility as an accurate predictor of the outcome in patients with ACLF. Increasing HARI and a decreasing PVv are predictors of an adverse outcome. Delta-HARI and delta-PVv are new biomarkers of prognosis and ACLF-related mortality in patients with liver diseases. Delta-HARI and delta-PVv may be helpful in guiding clinical decision-making, especially in catecholamine and fluid management.

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Section: Discussionsupporting

confidence: 89%

Hepatic perfusion as a new predictor of prognosis and mortality in critical care patients with acute-on-chronic liver failure

et al. 2022

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“…Therefore, a more detailed evaluation of the risk for disease progression is warranted. We have recently published two studies regarding the identification of patients who may progress to severe disease following the transfer to a liver center 32,33 . In order to improve the prognosis of patients with ALF, management of the patients with ALI, including early identification of the patients, transfer to a live center, intervention based on accurate diagnosis, and detailed evaluation of the risk of disease progression are warranted.…”

Section: Discussionmentioning

confidence: 99%

Referral system has a diminished difference in the risk for hepatic encephalopathy development among each etiology in patients with acute liver injury

Kakisaka

Suzuki

Takahashi

et al. 2022

Hepatology Research

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Aim: Hepatic encephalopathy (HE) development is crucial in liver transplantation for patients with acute liver injury (ALI) and failure (ALF); to predict HE development, the Japan Hepatic Encephalopathy Prediction (JHEP) model, calculated using age, etiology, prothrombin time (PT), and total bilirubin, was established in 2004, and a referral system to the liver center was implemented using the JHEP model from April 2004. Methods:The JHEP model's ability to predict HE development in 460 consecutive patients with ALI between April 2004 and January 2021 using data from the referral system was evaluated, and the JHEP model was revised.Results: During the observation period, 7.8% patients developed HE. There was no difference in the proportion of HE development among the etiologies. In the Hosmer-Lemeshow test for HE development prediction, the JHEP model, revised JHEP (rJHEP) model, which was calculated without etiology data, and the modified JHEP model, which used the PT international ratio instead of PT in the rJHEP model, were good fitting models. Upon 30% random sampling from the total patients 60 times, the receiver operating curve analysis of both JHEP and rJHEP models for HE development was performed in all the datasets. The area under the curve of the JHEP model was subtracted from that of the rJHEP model (95% confidential interval, 0.000516-0.01793). Conclusions:The referral system using the JHEP model reduced the difference in the risk for HE development among each etiology; the rJHEP model had a better prediction ability for HE development than the JHEP model.

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“…A variety of other measures have been suggested as either additional or replacement measures to identify patients who will obtain a survival benefit from liver transplantation. These include the use of CT-based quantification of liver volume loss with a threshold of less than 1000 cm 3 , the presence of more than 75% necrosis in liver biopsy, abnormal contrast-enhanced ultrasound liver perfusion patterns and the elevation of serologic markers of fibrosis as innovative negative prognostic indicators [83,84,85 ▪ ,86].…”

Section: Prognostic Assessment and Liver Transplantationmentioning

confidence: 99%

Acute liver failure

Vasques

Cavazza

Bernal

2022

Current Opinion in Critical Care

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Purpose of reviewPresent an outline of acute liver failure, from its definition to its management in critical care, updated with findings of selected newer research. Recent findingsSurvival of patients with acute liver failure has progressively improved. Intracranial hypertension complicating hepatic encephalopathy is now much less frequent than in the past and invasive ICP monitoring is now rarely used. Early renal replacement therapy and possibly therapeutic plasma exchange have consolidated their role in the treatment. Further evidence confirms the low incidence of bleeding in these patients despite striking abnormalities in standard tests of coagulation and new findings of abnormalities on thromboelastographic testing. Specific coagulopathy profiles including an abnormal vWF/ADAMTS13 ratio may be associated with poor outcome and increased bleeding risk. Use of Nacetylcysteine in nonparacetamol-related cases remains unsupported by robust clinical evidence. New microRNA-based prognostic markers to select patients for transplantation are described but are still far from widespread clinical applicability; imaging-based prognostication tools are also promising. The use of extracorporeal artificial liver devices in clinical practice is yet to be supported by evidence. SummaryMedical treatment of patients with acute liver failure is now associated with significantly improved survival. Better prognostication and selection for emergency liver transplant may further improve care for these patients.

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Contrast‐Enhanced Ultrasonography–Based Hepatic Perfusion for Early Prediction of Prognosis in Acute Liver Failure

Cited by 18 publications

References 50 publications

Hepatic perfusion as a new predictor of prognosis and mortality in critical care patients with acute-on-chronic liver failure

Hepatic perfusion as a new predictor of prognosis and mortality in critical care patients with acute-on-chronic liver failure

Referral system has a diminished difference in the risk for hepatic encephalopathy development among each etiology in patients with acute liver injury

Acute liver failure

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