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

Area of Science:

• Neurology
• Hepatology
• Critical Care Medicine

Background:

• Acute liver failure (ALF) is a critical condition associated with high mortality, often complicated by cerebral edema and increased intracranial pressure.
• Optic nerve sheath diameter (ONSD) elevation, detectable via ultrasound, is a potential non-invasive indicator of intracranial pressure.
• Assessing ONSD's feasibility, safety, and prognostic value in ALF patients is crucial for improving patient management.

Purpose of the Study:

• To evaluate the feasibility and safety of measuring ONSD in critically ill ALF patients.
• To determine the association between ONSD measurements and hospital mortality in ALF.
• To explore ONSD as a potential prognostic biomarker in ALF.

Main Methods:

• An open-label prospective cohort study was conducted in an academic liver intensive care unit.
• Adult ALF patients underwent serial ONSD measurements using ultrasound.
• Hospital mortality served as the primary outcome, with intention-to-treat and per-protocol analyses performed.

Main Results:

• The mean ONSD was significantly higher in non-survivors compared to survivors (p=0.004).
• A strong correlation was observed between right and left eye ONSD measurements (r=0.90).
• No adverse events were reported during ONSD measurements, indicating high safety.

Conclusions:

• Elevated ONSD in ALF patients is significantly associated with increased hospital mortality.
• ONSD measurement is a feasible, safe, and potentially valuable prognostic tool in ALF.
• This non-invasive method may aid in risk stratification and clinical decision-making for ALF patients.