Murphy, Nick;
El-Dalil, Philip;
Patel, Sameer;
Ryan, Jenifer;
Bangash, Mansoor;
Agarwal, Banwari;
Jalan, Rajiv;
... Bernal, William; + view all
(2025)
Use of intracranial pressure monitoring and risk factors for the development of intracranial hypertension in acute liver failure.
Journal of Hepatology
10.1016/j.jhep.2025.12.007.
(In press).
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1-s2.0-S0168827825027254-main.pdf - Accepted Version Access restricted to UCL open access staff until 18 December 2026. Download (7MB) |
Abstract
Background and aims: The use of invasive intracranial pressure monitors (IIPM) in acute liver failure (ALF) is controversial. The incidence of intracranial hypertension (ICH) in ALF appears to have fallen since it was first recognised and the risk benefit ratio of the use of IIPM has been questioned. Anecdotal reports suggest that the use of IIPM has fallen significantly in the UK. We investigated the use of IIPM, the incidence of and factors related to, ICH and cerebral death (CD). / / Methods: This retrospective cohort study collected data on consecutive patients with ALF, admitted to three liver transplant centres in the UK from 2009 to 2018 from prospective audits. Data on the incidence of ICH, CD, the use of IIPM, liver transplantation and hospital survival were collected. Factors associated with ICH and CD were investigated. / / Results: The incidence of intracranial hypertension (ICH) fell over the study period from 13% in 2009 to 3% in 2018 (p<0.001). The use of IIPM fell over the study period from 20.6% of patients admitted in 2009, (n=13), to 1.4% (n=1) in 2018, (p<0.001). Hospital survival, liver transplantation and cerebral deaths did not vary significantly during this period. Peak arterial ammonia concentration had close association to both ICH and CD. / / Discussion: In three high-volume liver transplant units, the use of invasive ICP monitoring fell significantly over a ten-year period and was not associated with worsening outcomes. Based on the data presented it can be suggested that a focus on early preventative measures without invasive ICP monitoring is a rational approach and does not lead to adverse outcomes, including ICH, CD or increased mortality. / / Impact and implications: With advances in ICU supportive care, the incidence of intracranial hypertension as a complication of ALF, has fallen. Serum ammonia levels are central to the pathogenesis and risk stratification. Invasive ICP monitoring remains the gold standard for detection, but availability, concerns about utility and complications have limited its application. Our study shows that a reduction in use was not associated with a change in patient-centred outcomes.
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