ArticleLiver international : official journal of the International Association for the Study of the Liver2020
Serum osmolality, cerebrospinal fluid specific gravity and overt hepatic encephalopathy severity in patients with liver failure.
Article in Liver international : official journal of the International Association for the Study of the Liver, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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6 citing papers in PubMed, 8 citations in OpenAlex.
- Covert hepatic encephalopathy as a multi-organ syndrome: the gut-liver-muscle-brain axis, diagnosis, treatment, and multidisciplinary care.Journal of gastroenterology · 2026Review
- Biocompatible Ink Optimization Enables Functional Volumetric Bioprinting With Xolography.Advanced materials (Deerfield Beach, Fla.) · 2026Article
- The U-shaped relationship between serum osmolality and the risk of sepsis-associated delirium development: a retrospective study.BMC neurology · 2025Article
- Association between osmolality trajectories and mortality in patients with sepsis: a group-based trajectory model in large ICU open access databases.Frontiers in medicine · 2025Article
- Hyperosmolarity in children with hyperammonemia: a risk of brain herniation at the start of renal replacement therapy.Frontiers in pediatrics · 2024Article
- Cerebral edema and liver disease: Classic perspectives and contemporary hypotheses on mechanism.Neuroscience letters · 2020Review
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9 authors at 4 institutions in 2 countries.
Funding
Abstract
BACKGROUND AND
aimsHepatic encephalopathy (HE) is a leading contributor to morbidity in liver disease. While hyperammonaemia plays a key role, the mechanisms of cerebral toxicity are unclear. We hypothesized that serum hyperosmolality contributes to HE during acute (ALF) and acute-on-chronic liver failure (ACLF) through mechanisms that affect the water and solute composition of the cerebral environment.
methodsWe performed a retrospective analysis of serum osmolality, cerebral spinal fluid (CSF) solute density (specific gravity, determined from computed tomography attenuation) and clinical HE severity (Glasgow Coma Score [GCS]) at the time of intensive care admission in a prospectively identified cohort of liver failure patients with overt HE.
resultsSeventy-three patients (39 ALF and 34 ACLF) were included, of whom 28 (38%) were comatose. Serum osmolality (303.9 ± 15.4 mOsm/kg) was elevated despite normal serum sodium (136.6 ± 6.3 mEq/L). Increased osmolality was independently associated with more severe encephalopathy (ordinal adjusted OR 0.26 [95% CI 0.22, 0.31] for higher GCS per standard deviation increase in osmolality) and lower CSF-specific gravity (linear adjusted β = -0.039 [95% CI -0.069, -0.009] Hounsfield unit per 1 mOsm/kg).
conclusionsIn the context of related research, these data suggest that hyperosmolality increases brain exposure to metabolic toxins by blood-brain barrier alteration and may be a unique therapeutic target.
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