脑CT扫描诊断和预后价值在急性肝衰竭和脑患者:一个多中心队列研究
Filipe S Cardoso1,2, William M Lee3, Constantine J Karvellas2
1Intensive Care Unit, Transplant Unit, Curry Cabral Hospital, Nova Medical School, Lisbon, Portugal.
Critical care explorations
|April 15, 2025
概括
通过CT扫描识别的急性肝衰竭 (ALF) 患者的脑与较差的无移植生存率有关. 然而,CT发现并没有阻止肝移植的选择,这表明其具有诊断和预后效用.
科学领域:
- 肝病学和神经病学 肝病学和神经学
- 在重症监护中的诊断成像.
背景情况:
- 急性肝衰竭 (ALF) 具有重大风险,包括发展大脑.
- 在ALF患者中脑的诊断和预后影响需要进一步阐明.
研究的目的:
- 调查CT扫描在识别ALF患者中脑 edem 的诊断和预后价值.
- 评估ALF中脑和21天无移植生存 (TFS) 之间的关联.
主要方法:
- 美国多中心ALF注册表的回顾性分析 (1998年1月 - 2016年8月).
- 包括连续ALF患者,他们接受了脑CT扫描.
- 主要暴露:CT扫描中的脑;主要终点:21天的TFS.
主要成果:
- 在2108名ALF患者中,有243人 (11.5%) 接受了CT扫描;有105人 (43.2%) 显示脑.
- 大脑与年轻的年龄,女性性别,乙氨基病因,增加机械通风和更高的MELD得分有关.
- 调整后的分析显示,脑独立与较低的21天TFS相关 (aOR=0.36),但并不排除肝移植选择.
结论:
- 随着时间的推移,ALF患者的CT扫描利用率有所增加,大脑瘤在很大程度上被发现.
- 在CT上脑是ALF中21天TFS恶化的独立预测因素.
- 脑CT扫描在精选的ALF病例中提供了有价值的诊断和预后信息,有助于临床决策.
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