The Experts below are selected from a list of 4329 Experts worldwide ranked by ideXlab platform
Rajiv Jalan - One of the best experts on this subject based on the ideXlab platform.
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modification in csf Specific Gravity in acutely decompensated cirrhosis and acute on chronic liver failure independent of encephalopathy evidences for an early blood csf barrier dysfunction in cirrhosis
Metabolic Brain Disease, 2017Co-Authors: Nicolas Weiss, Matteo Rosselli, Sarah Mouri, Damien Galanaud, Louis Puybasset, Banwari Agarwal, Dominique Thabut, Rajiv JalanAbstract:Although hepatic encephalopathy (HE) on the background of acute on chronic liver failure (ACLF) is associated with high mortality rates, it is unknown whether this is due to increased blood-brain barrier permeability. Specific Gravity of cerebrospinal Fluid measured by CT is able to estimate blood-cerebrospinal Fluid-barrier permeability. This study aimed to assess cerebrospinal Fluid Specific Gravity in acutely decompensated cirrhosis and to compare it in patients with or without ACLF and with or without hepatic encephalopathy. We identified all the patients admitted for acute decompensation of cirrhosis who underwent a brain CT-scan. Those patients could present acute decompensation with or without ACLF. The presence of hepatic encephalopathy was noted. They were compared to a group of stable cirrhotic patients and healthy controls. Quantitative brain CT analysis used the Brainview software that gives the weight, the volume and the Specific Gravity of each determined brain regions. Results are given as median and interquartile ranges and as relative variation compared to the control/baseline group. 36 patients presented an acute decompensation of cirrhosis. Among them, 25 presented with ACLF and 11 without ACLF; 20 presented with hepatic encephalopathy grade ≥ 2. They were compared to 31 stable cirrhosis patients and 61 healthy controls. Cirrhotic patients had increased cerebrospinal Fluid Specific Gravity (CSF-SG) compared to healthy controls (+0.4 %, p < 0.0001). Cirrhotic patients with ACLF have decreased CSF-SG as compared to cirrhotic patients without ACLF (−0.2 %, p = 0.0030) that remained higher than in healthy controls. The presence of hepatic encephalopathy did not modify CSF-SG (−0.09 %, p = 0.1757). Specific Gravity did not differ between different brain regions according to the presence or absence of either ACLF or HE. In patients with acute decompensation of cirrhosis, and those with ACLF, CSF Specific Gravity is modified compared to both stable cirrhotic patients and healthy controls. This pattern is observed even in the absence of hepatic encephalopathy suggesting that blood-CSF barrier impairment is manifest even in absence of overt hepatic encephalopathy.
Matthew B Maas - One of the best experts on this subject based on the ideXlab platform.
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serum osmolality cerebrospinal Fluid Specific Gravity and overt hepatic encephalopathy severity in patients with liver failure
Liver International, 2020Co-Authors: Eric M Liotta, Constantine J Karvellas, Minjee Kim, Ayush Batra, Andrew M Naidech, Shyam Prabhakaran, Farzaneh A Sorond, Taylor W Kimberly, Matthew B MaasAbstract:Background and aims Hepatic 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. Methods We 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. Results Seventy-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). Conclusions In 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.
Nicolas Weiss - One of the best experts on this subject based on the ideXlab platform.
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modification in csf Specific Gravity in acutely decompensated cirrhosis and acute on chronic liver failure independent of encephalopathy evidences for an early blood csf barrier dysfunction in cirrhosis
Metabolic Brain Disease, 2017Co-Authors: Nicolas Weiss, Matteo Rosselli, Sarah Mouri, Damien Galanaud, Louis Puybasset, Banwari Agarwal, Dominique Thabut, Rajiv JalanAbstract:Although hepatic encephalopathy (HE) on the background of acute on chronic liver failure (ACLF) is associated with high mortality rates, it is unknown whether this is due to increased blood-brain barrier permeability. Specific Gravity of cerebrospinal Fluid measured by CT is able to estimate blood-cerebrospinal Fluid-barrier permeability. This study aimed to assess cerebrospinal Fluid Specific Gravity in acutely decompensated cirrhosis and to compare it in patients with or without ACLF and with or without hepatic encephalopathy. We identified all the patients admitted for acute decompensation of cirrhosis who underwent a brain CT-scan. Those patients could present acute decompensation with or without ACLF. The presence of hepatic encephalopathy was noted. They were compared to a group of stable cirrhotic patients and healthy controls. Quantitative brain CT analysis used the Brainview software that gives the weight, the volume and the Specific Gravity of each determined brain regions. Results are given as median and interquartile ranges and as relative variation compared to the control/baseline group. 36 patients presented an acute decompensation of cirrhosis. Among them, 25 presented with ACLF and 11 without ACLF; 20 presented with hepatic encephalopathy grade ≥ 2. They were compared to 31 stable cirrhosis patients and 61 healthy controls. Cirrhotic patients had increased cerebrospinal Fluid Specific Gravity (CSF-SG) compared to healthy controls (+0.4 %, p < 0.0001). Cirrhotic patients with ACLF have decreased CSF-SG as compared to cirrhotic patients without ACLF (−0.2 %, p = 0.0030) that remained higher than in healthy controls. The presence of hepatic encephalopathy did not modify CSF-SG (−0.09 %, p = 0.1757). Specific Gravity did not differ between different brain regions according to the presence or absence of either ACLF or HE. In patients with acute decompensation of cirrhosis, and those with ACLF, CSF Specific Gravity is modified compared to both stable cirrhotic patients and healthy controls. This pattern is observed even in the absence of hepatic encephalopathy suggesting that blood-CSF barrier impairment is manifest even in absence of overt hepatic encephalopathy.
Eric M Liotta - One of the best experts on this subject based on the ideXlab platform.
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serum osmolality cerebrospinal Fluid Specific Gravity and overt hepatic encephalopathy severity in patients with liver failure
Liver International, 2020Co-Authors: Eric M Liotta, Constantine J Karvellas, Minjee Kim, Ayush Batra, Andrew M Naidech, Shyam Prabhakaran, Farzaneh A Sorond, Taylor W Kimberly, Matthew B MaasAbstract:Background and aims Hepatic 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. Methods We 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. Results Seventy-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). Conclusions In 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.
Dominique Thabut - One of the best experts on this subject based on the ideXlab platform.
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modification in csf Specific Gravity in acutely decompensated cirrhosis and acute on chronic liver failure independent of encephalopathy evidences for an early blood csf barrier dysfunction in cirrhosis
Metabolic Brain Disease, 2017Co-Authors: Nicolas Weiss, Matteo Rosselli, Sarah Mouri, Damien Galanaud, Louis Puybasset, Banwari Agarwal, Dominique Thabut, Rajiv JalanAbstract:Although hepatic encephalopathy (HE) on the background of acute on chronic liver failure (ACLF) is associated with high mortality rates, it is unknown whether this is due to increased blood-brain barrier permeability. Specific Gravity of cerebrospinal Fluid measured by CT is able to estimate blood-cerebrospinal Fluid-barrier permeability. This study aimed to assess cerebrospinal Fluid Specific Gravity in acutely decompensated cirrhosis and to compare it in patients with or without ACLF and with or without hepatic encephalopathy. We identified all the patients admitted for acute decompensation of cirrhosis who underwent a brain CT-scan. Those patients could present acute decompensation with or without ACLF. The presence of hepatic encephalopathy was noted. They were compared to a group of stable cirrhotic patients and healthy controls. Quantitative brain CT analysis used the Brainview software that gives the weight, the volume and the Specific Gravity of each determined brain regions. Results are given as median and interquartile ranges and as relative variation compared to the control/baseline group. 36 patients presented an acute decompensation of cirrhosis. Among them, 25 presented with ACLF and 11 without ACLF; 20 presented with hepatic encephalopathy grade ≥ 2. They were compared to 31 stable cirrhosis patients and 61 healthy controls. Cirrhotic patients had increased cerebrospinal Fluid Specific Gravity (CSF-SG) compared to healthy controls (+0.4 %, p < 0.0001). Cirrhotic patients with ACLF have decreased CSF-SG as compared to cirrhotic patients without ACLF (−0.2 %, p = 0.0030) that remained higher than in healthy controls. The presence of hepatic encephalopathy did not modify CSF-SG (−0.09 %, p = 0.1757). Specific Gravity did not differ between different brain regions according to the presence or absence of either ACLF or HE. In patients with acute decompensation of cirrhosis, and those with ACLF, CSF Specific Gravity is modified compared to both stable cirrhotic patients and healthy controls. This pattern is observed even in the absence of hepatic encephalopathy suggesting that blood-CSF barrier impairment is manifest even in absence of overt hepatic encephalopathy.