ArticleCritical care medicine2018
Osmotic Shifts, Cerebral Edema, and Neurologic Deterioration in Severe Hepatic Encephalopathy.
Article in Critical care medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
16 citing papers in PubMed, 30 citations in OpenAlex.
- Quantitative CT-scan to evaluate cerebral edema secondary to hyperammonemia in ICU: A proof-of-concept study.Journal of intensive medicine · 2026Article
- Is FIB-4 Index an Independent Risk Factor for Hematoma Expansion in Acute Intracerebral Hemorrhage? A Retrospective Multicenter Observational Cohort Study.Journal of clinical medicine · 2026Article
- Brain CT Scan Diagnostic and Prognostic Value in Patients With Acute Liver Failure and Cerebral Edema: A Multicenter Cohort Study.Critical care explorations · 2025Article
- Case Report: Management of intracranial hypertension in acute-on-chronic liver failure: a case of fulminant cerebral edema and acute-onset severe hyperammonemia in a patient with cirrhosis.Frontiers in gastroenterology (Lausanne, Switzerland) · 2025Article
- Hyperosmolarity in children with hyperammonemia: a risk of brain herniation at the start of renal replacement therapy.Frontiers in pediatrics · 2024Article
- Liver fibrosis score is associated with the mortality of traumatic brain injury patients.Neurosurgical review · 2023Article
- Expert consensus on liver transplantation perioperative evaluation and rehabilitation for acute-on-chronic liver failure.Liver research (Beijing, China) · 2022Article
- Article
- Not all that trembles…: a rare case of extrapyramidal impairment.Internal and emergency medicine · 2021Article
- Consensus guidelines for management of hyperammonaemia in paediatric patients receiving continuous kidney replacement therapy.Nature reviews. Nephrology · 2020Review
- Serum osmolality, cerebrospinal fluid specific gravity and overt hepatic encephalopathy severity in patients with liver failure.Liver international : official journal of the International Association for the Study of the Liver · 2020Article
- Hyponatremia in the Neurologically Ill Patient: A Review.The Neurohospitalist · 2020Review
- Cerebral edema and liver disease: Classic perspectives and contemporary hypotheses on mechanism.Neuroscience letters · 2020Review
- Cerebral Herniation from Hyperammonemic Cerebral Edema: A Potentially Reversible Neurological Emergency.Neurocritical care · 2019Article
- The authors reply.Critical care medicine · 2018Article
- Acute pediatric hyperammonemia: current diagnosis and management strategies.Hepatic medicine : evidence and research · 2018Review
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15 authors at 3 institutions in 1 country.
Funding
Abstract
objectivesWe sought to determine the effect of acute electrolyte and osmolar shifts on brain volume and neurologic function in patients with liver failure and severe hepatic encephalopathy.
designRetrospective analysis of brain CT scans and clinical data.
settingTertiary care hospital ICUs. PATIENTS: Patients with acute or acute-on-chronic liver failure and severe hepatic encephalopathy.
interventionsClinically indicated CT scans and serum laboratory studies. MEASUREMENTS AND MAIN
resultsChange in intracranial cerebrospinal fluid volume between sequential CT scans was measured as a biomarker of acute brain volume change. Corresponding changes in serum osmolality, chemistry measurements, and Glasgow Coma Scale were determined. Associations with cerebrospinal fluid volume change and Glasgow Coma Scale change for initial volume change assessments were identified by Spearman's correlations (rs) and regression models. Consistency of associations with repeated assessments was evaluated using generalized estimating equations. Forty patients were included. Median baseline osmolality was elevated (310 mOsm/Kg [296-321 mOsm/Kg]) whereas sodium was normal (137 mEq/L [134-142 mEq/L]). Median initial osmolality change was 9 mOsm/kg (5-17 mOsm/kg). Neuroimaging consistent with increased brain volume occurred in 27 initial assessments (68%). Cerebrospinal fluid volume change was more strongly correlated with osmolality (r = 0.70; p = 4 × 10) than sodium (r = 0.28; p = 0.08) change. Osmolality change was independently associated with Glasgow Coma Scale change (p = 1 × 10) and cerebrospinal fluid volume change (p = 2.7 × 10) in initial assessments and in generalized estimating equations using all 103 available assessments.
conclusionsAcute decline in osmolality was associated with brain swelling and neurologic deterioration in severe hepatic encephalopathy. Minimizing osmolality decline may avoid neurologic deterioration.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.