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

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.

International multicenter retrospective cohort.

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

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

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

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).

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.