Infection and systemic inflammation, not ammonia, are associated with Grade 3/4 hepatic encephalopathy, but not mortality in cirrhosis
Background & Aims Patients with cirrhosis are prone to infection which is a frequent precipitant of hepatic encephalopathy (HE). Clinical studies have examined the importance of inflammation and infection in modulating the manifestation of symptoms of HE in acute liver failure and patients with...
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| Veröffentlicht in: | Journal of hepatology 2011-04, Vol.54 (4), p.640-649 |
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| creator | Shawcross, D.L Sharifi, Y Canavan, J.B Yeoman, A.D Abeles, R.D Taylor, N.J Auzinger, G Bernal, W Wendon, J.A |
| description | Background & Aims Patients with cirrhosis are prone to infection which is a frequent precipitant of hepatic encephalopathy (HE). Clinical studies have examined the importance of inflammation and infection in modulating the manifestation of symptoms of HE in acute liver failure and patients with cirrhosis and minimal/low grade HE. It would be logical to presume that this relationship persists in patients who develop severe HE in cirrhosis although this has not been examined to date. Methods We report the findings of a prospective audit of 100 consecutive patients with cirrhosis admitted between Jan 2000 and March 2008 to a liver Intensive Care Unit (ICU) where HE was the primary indication for admission (59% Grade 3; 41% Grade 4). Haematological and microbiological data were collected at ICU admission, and organ scores and outcomes were recorded. Results 46% of patients had positive cultures taken within ±48 h from admission to ICU [25% blood] and a further 22% were culture negative but had evidence of systemic inflammation (SIRS). SIRS score ( p = 0.03) and SOFA score ( p = 0.006) were significantly higher in those patients with Grade 4 HE, who were also less likely to survive ( p |
| doi_str_mv | 10.1016/j.jhep.2010.07.045 |
| format | Article |
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Clinical studies have examined the importance of inflammation and infection in modulating the manifestation of symptoms of HE in acute liver failure and patients with cirrhosis and minimal/low grade HE. It would be logical to presume that this relationship persists in patients who develop severe HE in cirrhosis although this has not been examined to date. Methods We report the findings of a prospective audit of 100 consecutive patients with cirrhosis admitted between Jan 2000 and March 2008 to a liver Intensive Care Unit (ICU) where HE was the primary indication for admission (59% Grade 3; 41% Grade 4). Haematological and microbiological data were collected at ICU admission, and organ scores and outcomes were recorded. Results 46% of patients had positive cultures taken within ±48 h from admission to ICU [25% blood] and a further 22% were culture negative but had evidence of systemic inflammation (SIRS). SIRS score ( p = 0.03) and SOFA score ( p = 0.006) were significantly higher in those patients with Grade 4 HE, who were also less likely to survive ( p <0.001). HE grade/coma score did not correlate with ammonia, biochemistry or MELD score. Fifty-two percent of patients survived their ICU stay while the remainder developed progressive multiorgan failure and died; 38% survived to discharge, and 16% were transplanted. Conclusions These data support an association between infection/SIRS and not ammonia, in patients with cirrhosis that develop severe HE. The presence or absence of infection/SIRS did not determine survival.</description><identifier>ISSN: 0168-8278</identifier><identifier>EISSN: 1600-0641</identifier><identifier>DOI: 10.1016/j.jhep.2010.07.045</identifier><identifier>PMID: 21163546</identifier><identifier>CODEN: JOHEEC</identifier><language>eng</language><publisher>Kidlington: Elsevier B.V</publisher><subject>Adult ; Ammonia - blood ; Biological and medical sciences ; Cirrhosis ; Critical Care ; Female ; Gastroenterology and Hepatology ; Gastroenterology. Liver. Pancreas. Abdomen ; Hepatic encephalopathy ; Hepatic Encephalopathy - blood ; Hepatic Encephalopathy - etiology ; Hepatic Encephalopathy - mortality ; Hepatitis A - complications ; Hepatitis A - microbiology ; Humans ; Infection ; Inflammation ; Kaplan-Meier Estimate ; Liver Cirrhosis - blood ; Liver Cirrhosis - complications ; Liver Cirrhosis - mortality ; Liver. Biliary tract. Portal circulation. Exocrine pancreas ; Male ; Medical sciences ; Middle Aged ; Other diseases. Semiology ; Outcomes ; Prospective Studies ; Systemic Inflammatory Response Syndrome - complications</subject><ispartof>Journal of hepatology, 2011-04, Vol.54 (4), p.640-649</ispartof><rights>European Association for the Study of the Liver</rights><rights>2010 European Association for the Study of the Liver</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2010 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c440t-e3bcd024bd2345dd59920e005401922d1d2449b53074c683c1b4717b542f613d3</citedby><cites>FETCH-LOGICAL-c440t-e3bcd024bd2345dd59920e005401922d1d2449b53074c683c1b4717b542f613d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jhep.2010.07.045$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>315,782,786,3552,27931,27932,46002</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=23922494$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21163546$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shawcross, D.L</creatorcontrib><creatorcontrib>Sharifi, Y</creatorcontrib><creatorcontrib>Canavan, J.B</creatorcontrib><creatorcontrib>Yeoman, A.D</creatorcontrib><creatorcontrib>Abeles, R.D</creatorcontrib><creatorcontrib>Taylor, N.J</creatorcontrib><creatorcontrib>Auzinger, G</creatorcontrib><creatorcontrib>Bernal, W</creatorcontrib><creatorcontrib>Wendon, J.A</creatorcontrib><title>Infection and systemic inflammation, not ammonia, are associated with Grade 3/4 hepatic encephalopathy, but not mortality in cirrhosis</title><title>Journal of hepatology</title><addtitle>J Hepatol</addtitle><description>Background & Aims Patients with cirrhosis are prone to infection which is a frequent precipitant of hepatic encephalopathy (HE). Clinical studies have examined the importance of inflammation and infection in modulating the manifestation of symptoms of HE in acute liver failure and patients with cirrhosis and minimal/low grade HE. It would be logical to presume that this relationship persists in patients who develop severe HE in cirrhosis although this has not been examined to date. Methods We report the findings of a prospective audit of 100 consecutive patients with cirrhosis admitted between Jan 2000 and March 2008 to a liver Intensive Care Unit (ICU) where HE was the primary indication for admission (59% Grade 3; 41% Grade 4). Haematological and microbiological data were collected at ICU admission, and organ scores and outcomes were recorded. Results 46% of patients had positive cultures taken within ±48 h from admission to ICU [25% blood] and a further 22% were culture negative but had evidence of systemic inflammation (SIRS). SIRS score ( p = 0.03) and SOFA score ( p = 0.006) were significantly higher in those patients with Grade 4 HE, who were also less likely to survive ( p <0.001). HE grade/coma score did not correlate with ammonia, biochemistry or MELD score. Fifty-two percent of patients survived their ICU stay while the remainder developed progressive multiorgan failure and died; 38% survived to discharge, and 16% were transplanted. Conclusions These data support an association between infection/SIRS and not ammonia, in patients with cirrhosis that develop severe HE. The presence or absence of infection/SIRS did not determine survival.</description><subject>Adult</subject><subject>Ammonia - blood</subject><subject>Biological and medical sciences</subject><subject>Cirrhosis</subject><subject>Critical Care</subject><subject>Female</subject><subject>Gastroenterology and Hepatology</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>Hepatic encephalopathy</subject><subject>Hepatic Encephalopathy - blood</subject><subject>Hepatic Encephalopathy - etiology</subject><subject>Hepatic Encephalopathy - mortality</subject><subject>Hepatitis A - complications</subject><subject>Hepatitis A - microbiology</subject><subject>Humans</subject><subject>Infection</subject><subject>Inflammation</subject><subject>Kaplan-Meier Estimate</subject><subject>Liver Cirrhosis - blood</subject><subject>Liver Cirrhosis - complications</subject><subject>Liver Cirrhosis - mortality</subject><subject>Liver. Biliary tract. Portal circulation. Exocrine pancreas</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Other diseases. Semiology</subject><subject>Outcomes</subject><subject>Prospective Studies</subject><subject>Systemic Inflammatory Response Syndrome - complications</subject><issn>0168-8278</issn><issn>1600-0641</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9ksuKFDEUQIMoTjv6Ay4kG3HT1XPzqBeIIIOOAwMuVHAXUkmKSlmVtElKqR_wu03ZrYILVyHJuY-cXISeEjgQINXVeBgHczxQyAdQH4CX99COVAAFVJzcR7sMNUVD6-YCPYpxBAAGLX-ILighFSt5tUM_bl1vVLLeYek0jmtMZrYKW9dPcp7ldrPHziecd95ZuccyGCxj9MrKZDT-btOAb4LUBrMrjnNHOUhh45Q5DnLyeTuse9wt6Vea2YckJ5vWXAIrG8Lgo42P0YNeTtE8Oa-X6NPbNx-v3xV3729ur1_fFYpzSIVhndJAeacp46XWZdtSMAAlB9JSqommnLddyaDmqmqYIh2vSd2VnPYVYZpdohenvMfgvy4mJjHbqMw0SWf8EkVT1g2hDWGZpCdSBR9jML04BjvLsAoCYtMvRrHpF5t-AbXI-nPQs3P6pZuN_hPy23cGnp8BGZWc-iCdsvEvx_IreMsz9_LEmSzjmzVBRGU3pdqG_F1Ce_v_Pl79E64m62yu-MWsJo5-CS5rFkREKkB82AZlmxOSR6RhzWf2ExUVuHE</recordid><startdate>20110401</startdate><enddate>20110401</enddate><creator>Shawcross, D.L</creator><creator>Sharifi, Y</creator><creator>Canavan, J.B</creator><creator>Yeoman, A.D</creator><creator>Abeles, R.D</creator><creator>Taylor, N.J</creator><creator>Auzinger, G</creator><creator>Bernal, W</creator><creator>Wendon, J.A</creator><general>Elsevier B.V</general><general>Elsevier</general><scope>IQODW</scope><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>7X8</scope></search><sort><creationdate>20110401</creationdate><title>Infection and systemic inflammation, not ammonia, are associated with Grade 3/4 hepatic encephalopathy, but not mortality in cirrhosis</title><author>Shawcross, D.L ; Sharifi, Y ; Canavan, J.B ; Yeoman, A.D ; Abeles, R.D ; Taylor, N.J ; Auzinger, G ; Bernal, W ; Wendon, J.A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c440t-e3bcd024bd2345dd59920e005401922d1d2449b53074c683c1b4717b542f613d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adult</topic><topic>Ammonia - blood</topic><topic>Biological and medical sciences</topic><topic>Cirrhosis</topic><topic>Critical Care</topic><topic>Female</topic><topic>Gastroenterology and Hepatology</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>Hepatic encephalopathy</topic><topic>Hepatic Encephalopathy - blood</topic><topic>Hepatic Encephalopathy - etiology</topic><topic>Hepatic Encephalopathy - mortality</topic><topic>Hepatitis A - complications</topic><topic>Hepatitis A - microbiology</topic><topic>Humans</topic><topic>Infection</topic><topic>Inflammation</topic><topic>Kaplan-Meier Estimate</topic><topic>Liver Cirrhosis - blood</topic><topic>Liver Cirrhosis - complications</topic><topic>Liver Cirrhosis - mortality</topic><topic>Liver. Biliary tract. Portal circulation. Exocrine pancreas</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Other diseases. Semiology</topic><topic>Outcomes</topic><topic>Prospective Studies</topic><topic>Systemic Inflammatory Response Syndrome - complications</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Shawcross, D.L</creatorcontrib><creatorcontrib>Sharifi, Y</creatorcontrib><creatorcontrib>Canavan, J.B</creatorcontrib><creatorcontrib>Yeoman, A.D</creatorcontrib><creatorcontrib>Abeles, R.D</creatorcontrib><creatorcontrib>Taylor, N.J</creatorcontrib><creatorcontrib>Auzinger, G</creatorcontrib><creatorcontrib>Bernal, W</creatorcontrib><creatorcontrib>Wendon, J.A</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of hepatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shawcross, D.L</au><au>Sharifi, Y</au><au>Canavan, J.B</au><au>Yeoman, A.D</au><au>Abeles, R.D</au><au>Taylor, N.J</au><au>Auzinger, G</au><au>Bernal, W</au><au>Wendon, J.A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Infection and systemic inflammation, not ammonia, are associated with Grade 3/4 hepatic encephalopathy, but not mortality in cirrhosis</atitle><jtitle>Journal of hepatology</jtitle><addtitle>J Hepatol</addtitle><date>2011-04-01</date><risdate>2011</risdate><volume>54</volume><issue>4</issue><spage>640</spage><epage>649</epage><pages>640-649</pages><issn>0168-8278</issn><eissn>1600-0641</eissn><coden>JOHEEC</coden><abstract>Background & Aims Patients with cirrhosis are prone to infection which is a frequent precipitant of hepatic encephalopathy (HE). Clinical studies have examined the importance of inflammation and infection in modulating the manifestation of symptoms of HE in acute liver failure and patients with cirrhosis and minimal/low grade HE. It would be logical to presume that this relationship persists in patients who develop severe HE in cirrhosis although this has not been examined to date. Methods We report the findings of a prospective audit of 100 consecutive patients with cirrhosis admitted between Jan 2000 and March 2008 to a liver Intensive Care Unit (ICU) where HE was the primary indication for admission (59% Grade 3; 41% Grade 4). Haematological and microbiological data were collected at ICU admission, and organ scores and outcomes were recorded. Results 46% of patients had positive cultures taken within ±48 h from admission to ICU [25% blood] and a further 22% were culture negative but had evidence of systemic inflammation (SIRS). SIRS score ( p = 0.03) and SOFA score ( p = 0.006) were significantly higher in those patients with Grade 4 HE, who were also less likely to survive ( p <0.001). HE grade/coma score did not correlate with ammonia, biochemistry or MELD score. Fifty-two percent of patients survived their ICU stay while the remainder developed progressive multiorgan failure and died; 38% survived to discharge, and 16% were transplanted. Conclusions These data support an association between infection/SIRS and not ammonia, in patients with cirrhosis that develop severe HE. The presence or absence of infection/SIRS did not determine survival.</abstract><cop>Kidlington</cop><pub>Elsevier B.V</pub><pmid>21163546</pmid><doi>10.1016/j.jhep.2010.07.045</doi><tpages>10</tpages></addata></record> |
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| subjects | Adult Ammonia - blood Biological and medical sciences Cirrhosis Critical Care Female Gastroenterology and Hepatology Gastroenterology. Liver. Pancreas. Abdomen Hepatic encephalopathy Hepatic Encephalopathy - blood Hepatic Encephalopathy - etiology Hepatic Encephalopathy - mortality Hepatitis A - complications Hepatitis A - microbiology Humans Infection Inflammation Kaplan-Meier Estimate Liver Cirrhosis - blood Liver Cirrhosis - complications Liver Cirrhosis - mortality Liver. Biliary tract. Portal circulation. Exocrine pancreas Male Medical sciences Middle Aged Other diseases. Semiology Outcomes Prospective Studies Systemic Inflammatory Response Syndrome - complications |
| title | Infection and systemic inflammation, not ammonia, are associated with Grade 3/4 hepatic encephalopathy, but not mortality in cirrhosis |
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