Continuous EEG in Acute Liver Failure: Findings and Prognostic Value
Abstract number :
1.157
Submission category :
3. Neurophysiology / 3B. ICU EEG
Year :
2022
Submission ID :
2204222
Source :
www.aesnet.org
Presentation date :
12/3/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:24 AM
Authors :
Denise Chen, MD – University of Washington; Prem Kandiah, MD – Neurocritical Care – Emory University School of Medicine; Ioannis Karakis, MD, PhD, MSc – Neurology – Emory University School of Medicine; Rafael Perez Rodriguez, MD – Neurology – Emory University School of Medicine; Hiba Haider, MD – Neurology – University of Chicago Biological Sciences; Andres Rodriguez Ruiz, MD – Neurology – Emory University School of Medicine
Rationale: Neurologic complications contribute significantly to morbidity and mortality in acute liver failure (ALF), but evaluation of neurologic function in this population is often limited or unattainable due to illness severity. Continuous electroencephalography (cEEG) is a noninvasive tool which can monitor real-time cerebral function. We aimed to describe cEEG findings and prognostic significance of specific EEG features in ALF.
Methods: This was a retrospective study of 33 patients with ALF who underwent cEEG monitoring. ALF was defined as development of encephalopathy, coagulopathy (INR ≥ 1.5), and severe liver injury for < 26 weeks without preexisting chronic liver disease. Demographic, imaging, and clinical information were collected, including laboratory data (ammonia, creatinine, ALT, AST, total bilirubin, INR, platelet count) and treatments received (plasma exchange [PLEX], continuous renal replacement therapy [CRRT], molecular adsorbent recirculating system [MARS] therapy). cEEG studies were reviewed for background continuity and frequency, reactivity, and the presence of periodic and rhythmic patterns and seizures. The primary outcome was Cerebral Performance Category (CPC) score at discharge, dichotomized into good (CPC 1-2) versus poor (CPC 3-5) outcomes. Comparisons of demographic, clinical, and cEEG variables between the two outcome groups were performed using Fisher’s exact test for categorical variables and the Student t-test for continuous variables. Statistical analyses were performed in SAS.
Results: A total of 33 adult acute liver failure patients (70% female, median age 39 years) were included. The most common etiology for ALF was drug-induced liver injury (64%). Fifty-two percent of patients received MARS therapy, 25% underwent PLEX, 88% required CRRT, and 18% underwent liver transplantation during the index admission. The mortality rate was 61%. Of patients who underwent neuroimaging, 40% had abnormal imaging findings, with 27% of patients demonstrating cerebral edema. Six percent of patients exhibited seizures, all of which were clinical and generalized in onset. Fifty-eight percent had rhythmic or periodic patterns; generalized periodic discharges (GPDs, 42% of patients) and generalized rhythmic delta activity (GRDA, 18%) were the most common of these patterns.
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Neuroimaging findings, laboratory values, and treatments received were not statistically associated with clinical outcome. Patients with worse predominant background frequency and lack of EEG reactivity were more likely to have a poor outcome (p=0.002 and p=0.014, respectively). Patients with improvement in cEEG continuity (p=0.006), improvement in predominant background frequency (p=0.002), and GRDA (0.002) were more likely to have a good outcome. _x000D_
Conclusions: Our study is the first to describe cEEG findings in adult ALF patients and the association of specific cEEG parameters with clinical outcome, supporting the prognostic use of cEEG in this population.
Funding: None
Neurophysiology