Therapeutic hypothermia in acute liver failure: A multicenter retrospective cohort analysis
The benefit of therapeutic hypothermia (TH) in acute liver failure (ALF) has not been previously demonstrated in a controlled fashion. This study sought to determine the impact of TH on 21‐day survival and complications in ALF patients at high risk for cerebral edema. This was a retrospective cohort...
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| Veröffentlicht in: | Liver transplantation 2015-01, Vol.21 (1), p.4-12 |
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| description | The benefit of therapeutic hypothermia (TH) in acute liver failure (ALF) has not been previously demonstrated in a controlled fashion. This study sought to determine the impact of TH on 21‐day survival and complications in ALF patients at high risk for cerebral edema. This was a retrospective cohort study of ALF patients in the US Acute Liver Failure Study Group with grade III or IV hepatic encephalopathy. TH (32°C‐35°C) was used in 97 patients (8%); 1135 (92%) who were not cooled were controls. Intracranial pressure was monitored in 38 TH ALF patients (39.2% versus 22% of controls, P 0.5 for all) were similar. Unadjusted 21‐day overall (62% versus 60%) and transplant‐free survival rates (45% versus 39%, P > 0.4 for both) were similar. Multivariate models were created for acetaminophen (APAP) patients (n = 582) and non‐APAP patients (n = 613). For APAP patients, the Model for End‐Stage Liver Disease [MELD; odds ratio (OR) = 0.91 per increment, 95% confidence interval (CI) = 0.89‐0.94, P |
| doi_str_mv | 10.1002/lt.24021 |
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This study sought to determine the impact of TH on 21‐day survival and complications in ALF patients at high risk for cerebral edema. This was a retrospective cohort study of ALF patients in the US Acute Liver Failure Study Group with grade III or IV hepatic encephalopathy. TH (32°C‐35°C) was used in 97 patients (8%); 1135 (92%) who were not cooled were controls. Intracranial pressure was monitored in 38 TH ALF patients (39.2% versus 22% of controls, P < 0.001). Rates of bleeding (12% for both) and bloodstream (17% versus 18%) and tracheal infections (21% versus 23%, P > 0.5 for all) were similar. Unadjusted 21‐day overall (62% versus 60%) and transplant‐free survival rates (45% versus 39%, P > 0.4 for both) were similar. Multivariate models were created for acetaminophen (APAP) patients (n = 582) and non‐APAP patients (n = 613). For APAP patients, the Model for End‐Stage Liver Disease [MELD; odds ratio (OR) = 0.91 per increment, 95% confidence interval (CI) = 0.89‐0.94, P < 0.001] and vasopressors (OR = 0.16, 95% CI = 0.11‐0.24, P < 0.001) were associated with decreased 21‐day spontaneous survival. Survival was improved with TH in APAP patients who were <25 years old (age of 25 years: OR = 2.735, 95% CI = 1.001‐7.467) but worsened for APAP patients who were 64 years old or older (age of 64 years: OR = 0.167, 95% CI = 0.028‐0.999). For non‐APAP patients, MELD (OR = 0.93 per increment, 95% CI = 0.91‐0.95, P < 0.001) and vasopressors (OR = 0.60, 95% CI = 0.40‐0.90, P = 0.01) were associated with worse outcomes, whereas TH had no impact (P = 0.93). In conclusion, TH in ALF was not associated with increased bleeding or infections. Although young APAP ALF patients may benefit, TH did not consistently affect 21‐day survival. A prospective trial is required to clarify the utility of TH in ALF patients. Liver Transpl 21:4‐12, 2015. © 2014 AASLD.</description><identifier>ISSN: 1527-6465</identifier><identifier>EISSN: 1527-6473</identifier><identifier>DOI: 10.1002/lt.24021</identifier><identifier>PMID: 25308108</identifier><identifier>CODEN: LITRFO</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Acetaminophen - adverse effects ; Adult ; Analgesics, Non-Narcotic - adverse effects ; Brain Edema - diagnosis ; Brain Edema - etiology ; Brain Edema - mortality ; Brain Edema - therapy ; Chemical and Drug Induced Liver Injury - diagnosis ; Chemical and Drug Induced Liver Injury - etiology ; Chemical and Drug Induced Liver Injury - mortality ; Chemical and Drug Induced Liver Injury - therapy ; Chi-Square Distribution ; Female ; Humans ; Hypothermia, Induced - adverse effects ; Hypothermia, Induced - mortality ; Liver Failure, Acute - chemically induced ; Liver Failure, Acute - diagnosis ; Liver Failure, Acute - mortality ; Liver Failure, Acute - therapy ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Registries ; Retrospective Studies ; Risk Factors ; Time Factors ; Treatment Outcome ; United States</subject><ispartof>Liver transplantation, 2015-01, Vol.21 (1), p.4-12</ispartof><rights>2014 American Association for the Study of Liver Diseases</rights><rights>2014 American Association for the Study of Liver Diseases.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4531-dec565049af1bd2827c93f7e615426d619f1a34afc1ca3a32e6807973b651c7b3</citedby><cites>FETCH-LOGICAL-c4531-dec565049af1bd2827c93f7e615426d619f1a34afc1ca3a32e6807973b651c7b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Flt.24021$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Flt.24021$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,782,786,1419,27933,27934,45583,45584</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25308108$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Karvellas, Constantine J.</creatorcontrib><creatorcontrib>Todd Stravitz, R.</creatorcontrib><creatorcontrib>Battenhouse, Holly</creatorcontrib><creatorcontrib>Lee, William M.</creatorcontrib><creatorcontrib>Schilsky, Michael L.</creatorcontrib><creatorcontrib>US Acute Liver Failure Study Group</creatorcontrib><creatorcontrib>for the US Acute Liver Failure Study Group</creatorcontrib><title>Therapeutic hypothermia in acute liver failure: A multicenter retrospective cohort analysis</title><title>Liver transplantation</title><addtitle>Liver Transpl</addtitle><description>The benefit of therapeutic hypothermia (TH) in acute liver failure (ALF) has not been previously demonstrated in a controlled fashion. This study sought to determine the impact of TH on 21‐day survival and complications in ALF patients at high risk for cerebral edema. This was a retrospective cohort study of ALF patients in the US Acute Liver Failure Study Group with grade III or IV hepatic encephalopathy. TH (32°C‐35°C) was used in 97 patients (8%); 1135 (92%) who were not cooled were controls. Intracranial pressure was monitored in 38 TH ALF patients (39.2% versus 22% of controls, P < 0.001). Rates of bleeding (12% for both) and bloodstream (17% versus 18%) and tracheal infections (21% versus 23%, P > 0.5 for all) were similar. Unadjusted 21‐day overall (62% versus 60%) and transplant‐free survival rates (45% versus 39%, P > 0.4 for both) were similar. Multivariate models were created for acetaminophen (APAP) patients (n = 582) and non‐APAP patients (n = 613). For APAP patients, the Model for End‐Stage Liver Disease [MELD; odds ratio (OR) = 0.91 per increment, 95% confidence interval (CI) = 0.89‐0.94, P < 0.001] and vasopressors (OR = 0.16, 95% CI = 0.11‐0.24, P < 0.001) were associated with decreased 21‐day spontaneous survival. Survival was improved with TH in APAP patients who were <25 years old (age of 25 years: OR = 2.735, 95% CI = 1.001‐7.467) but worsened for APAP patients who were 64 years old or older (age of 64 years: OR = 0.167, 95% CI = 0.028‐0.999). For non‐APAP patients, MELD (OR = 0.93 per increment, 95% CI = 0.91‐0.95, P < 0.001) and vasopressors (OR = 0.60, 95% CI = 0.40‐0.90, P = 0.01) were associated with worse outcomes, whereas TH had no impact (P = 0.93). In conclusion, TH in ALF was not associated with increased bleeding or infections. Although young APAP ALF patients may benefit, TH did not consistently affect 21‐day survival. A prospective trial is required to clarify the utility of TH in ALF patients. Liver Transpl 21:4‐12, 2015. © 2014 AASLD.</description><subject>Acetaminophen - adverse effects</subject><subject>Adult</subject><subject>Analgesics, Non-Narcotic - adverse effects</subject><subject>Brain Edema - diagnosis</subject><subject>Brain Edema - etiology</subject><subject>Brain Edema - mortality</subject><subject>Brain Edema - therapy</subject><subject>Chemical and Drug Induced Liver Injury - diagnosis</subject><subject>Chemical and Drug Induced Liver Injury - etiology</subject><subject>Chemical and Drug Induced Liver Injury - mortality</subject><subject>Chemical and Drug Induced Liver Injury - therapy</subject><subject>Chi-Square Distribution</subject><subject>Female</subject><subject>Humans</subject><subject>Hypothermia, Induced - adverse effects</subject><subject>Hypothermia, Induced - mortality</subject><subject>Liver Failure, Acute - chemically induced</subject><subject>Liver Failure, Acute - diagnosis</subject><subject>Liver Failure, Acute - mortality</subject><subject>Liver Failure, Acute - therapy</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Odds Ratio</subject><subject>Registries</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>United States</subject><issn>1527-6465</issn><issn>1527-6473</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kE1LwzAch4Mobk7BTyABL14689IkrbcxfIOBl3nyENI0ZRnZWpNU6bc32unN0_-Fh4cfPwAuMZpjhMiti3OSI4KPwBQzIjKeC3r8t3M2AWchbBHCmJXoFEwIo6jAqJiCt_XGeNWZPloNN0PXxnTvrIJ2D5Xuo4HOfhgPG2Vd780dXMBd7xJs9jG9vYm-DZ3RMVFQt5vWR6j2yg3BhnNw0igXzMVhzsDrw_16-ZStXh6fl4tVpnNGcVYbzThDeakaXNWkIEKXtBGGY5YTXnNcNljRXDUaa0UVJYYXSJSCVpxhLSo6A9ejt_Pte29ClNu29ylEkJjTokRlSUSibkZKp8TBm0Z23u6UHyRG8rtF6aL8aTGhVwdhX-1M_Qf-1paAbAQ-rTPDvyK5Wo_CL8W-ey0</recordid><startdate>201501</startdate><enddate>201501</enddate><creator>Karvellas, Constantine J.</creator><creator>Todd Stravitz, R.</creator><creator>Battenhouse, Holly</creator><creator>Lee, William M.</creator><creator>Schilsky, Michael L.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope></search><sort><creationdate>201501</creationdate><title>Therapeutic hypothermia in acute liver failure: A multicenter retrospective cohort analysis</title><author>Karvellas, Constantine J. ; Todd Stravitz, R. ; Battenhouse, Holly ; Lee, William M. ; Schilsky, Michael L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4531-dec565049af1bd2827c93f7e615426d619f1a34afc1ca3a32e6807973b651c7b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Acetaminophen - adverse effects</topic><topic>Adult</topic><topic>Analgesics, Non-Narcotic - adverse effects</topic><topic>Brain Edema - diagnosis</topic><topic>Brain Edema - etiology</topic><topic>Brain Edema - mortality</topic><topic>Brain Edema - therapy</topic><topic>Chemical and Drug Induced Liver Injury - diagnosis</topic><topic>Chemical and Drug Induced Liver Injury - etiology</topic><topic>Chemical and Drug Induced Liver Injury - mortality</topic><topic>Chemical and Drug Induced Liver Injury - therapy</topic><topic>Chi-Square Distribution</topic><topic>Female</topic><topic>Humans</topic><topic>Hypothermia, Induced - adverse effects</topic><topic>Hypothermia, Induced - mortality</topic><topic>Liver Failure, Acute - chemically induced</topic><topic>Liver Failure, Acute - diagnosis</topic><topic>Liver Failure, Acute - mortality</topic><topic>Liver Failure, Acute - therapy</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Odds Ratio</topic><topic>Registries</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Karvellas, Constantine J.</creatorcontrib><creatorcontrib>Todd Stravitz, R.</creatorcontrib><creatorcontrib>Battenhouse, Holly</creatorcontrib><creatorcontrib>Lee, William M.</creatorcontrib><creatorcontrib>Schilsky, Michael L.</creatorcontrib><creatorcontrib>US Acute Liver Failure Study Group</creatorcontrib><creatorcontrib>for the US Acute Liver Failure Study Group</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><jtitle>Liver transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Karvellas, Constantine J.</au><au>Todd Stravitz, R.</au><au>Battenhouse, Holly</au><au>Lee, William M.</au><au>Schilsky, Michael L.</au><aucorp>US Acute Liver Failure Study Group</aucorp><aucorp>for the US Acute Liver Failure Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Therapeutic hypothermia in acute liver failure: A multicenter retrospective cohort analysis</atitle><jtitle>Liver transplantation</jtitle><addtitle>Liver Transpl</addtitle><date>2015-01</date><risdate>2015</risdate><volume>21</volume><issue>1</issue><spage>4</spage><epage>12</epage><pages>4-12</pages><issn>1527-6465</issn><eissn>1527-6473</eissn><coden>LITRFO</coden><abstract>The benefit of therapeutic hypothermia (TH) in acute liver failure (ALF) has not been previously demonstrated in a controlled fashion. This study sought to determine the impact of TH on 21‐day survival and complications in ALF patients at high risk for cerebral edema. This was a retrospective cohort study of ALF patients in the US Acute Liver Failure Study Group with grade III or IV hepatic encephalopathy. TH (32°C‐35°C) was used in 97 patients (8%); 1135 (92%) who were not cooled were controls. Intracranial pressure was monitored in 38 TH ALF patients (39.2% versus 22% of controls, P < 0.001). Rates of bleeding (12% for both) and bloodstream (17% versus 18%) and tracheal infections (21% versus 23%, P > 0.5 for all) were similar. Unadjusted 21‐day overall (62% versus 60%) and transplant‐free survival rates (45% versus 39%, P > 0.4 for both) were similar. Multivariate models were created for acetaminophen (APAP) patients (n = 582) and non‐APAP patients (n = 613). For APAP patients, the Model for End‐Stage Liver Disease [MELD; odds ratio (OR) = 0.91 per increment, 95% confidence interval (CI) = 0.89‐0.94, P < 0.001] and vasopressors (OR = 0.16, 95% CI = 0.11‐0.24, P < 0.001) were associated with decreased 21‐day spontaneous survival. Survival was improved with TH in APAP patients who were <25 years old (age of 25 years: OR = 2.735, 95% CI = 1.001‐7.467) but worsened for APAP patients who were 64 years old or older (age of 64 years: OR = 0.167, 95% CI = 0.028‐0.999). For non‐APAP patients, MELD (OR = 0.93 per increment, 95% CI = 0.91‐0.95, P < 0.001) and vasopressors (OR = 0.60, 95% CI = 0.40‐0.90, P = 0.01) were associated with worse outcomes, whereas TH had no impact (P = 0.93). In conclusion, TH in ALF was not associated with increased bleeding or infections. Although young APAP ALF patients may benefit, TH did not consistently affect 21‐day survival. A prospective trial is required to clarify the utility of TH in ALF patients. Liver Transpl 21:4‐12, 2015. © 2014 AASLD.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>25308108</pmid><doi>10.1002/lt.24021</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Acetaminophen - adverse effects Adult Analgesics, Non-Narcotic - adverse effects Brain Edema - diagnosis Brain Edema - etiology Brain Edema - mortality Brain Edema - therapy Chemical and Drug Induced Liver Injury - diagnosis Chemical and Drug Induced Liver Injury - etiology Chemical and Drug Induced Liver Injury - mortality Chemical and Drug Induced Liver Injury - therapy Chi-Square Distribution Female Humans Hypothermia, Induced - adverse effects Hypothermia, Induced - mortality Liver Failure, Acute - chemically induced Liver Failure, Acute - diagnosis Liver Failure, Acute - mortality Liver Failure, Acute - therapy Logistic Models Male Middle Aged Multivariate Analysis Odds Ratio Registries Retrospective Studies Risk Factors Time Factors Treatment Outcome United States |
| title | Therapeutic hypothermia in acute liver failure: A multicenter retrospective cohort analysis |
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