Optic nerve sheath diameters predict mortality and severity in hepatic encephalopathy

Area of Science:

• Neurology
• Hepatology
• Radiology

Background:

• Hepatic encephalopathy (HE) poses a significant challenge in managing cirrhosis patients.
• Accurate prediction of mortality and disease severity in HE is crucial for timely intervention.

Purpose of the Study:

• To evaluate the predictive capability of optic nerve sheath diameter (ONSD) via brain computed tomography (CT) for mortality and disease severity in emergency department patients with HE.
• To compare ONSD's predictive power against other established clinical and biochemical markers.

Main Methods:

• A cohort of 217 adult patients diagnosed with HE in the emergency department were included.
• A control group of 217 healthy individuals was used for comparison.
• Optic nerve sheath diameter (ONSD) was measured using brain CT scans in both groups.

Main Results:

• The mortality rate among HE patients was 32.7%, with 53% having late-stage disease.
• Optic nerve sheath diameter (ONSD), creatinine, lactate, and procalcitonin independently predicted mortality.
• Child-Pugh score, direct bilirubin, ONSD, ammonia, and total bilirubin independently predicted disease severity.
• Receiver operating characteristic curve analysis indicated ONSD had the highest predictive power for both mortality and disease severity.

Conclusions:

• Optic nerve sheath diameter (ONSD) measured by brain CT is a valuable, independent predictor of mortality and disease severity in patients with hepatic encephalopathy (HE).
• Integrating ONSD assessment into emergency department protocols can enhance clinical decision-making for HE patients.