Hepatic encephalopathy is associated with decreased cerebral oxygen metabolism and blood flow, not increased ammonia uptake

TY - JOUR

T1 - Hepatic encephalopathy is associated with decreased cerebral oxygen metabolism and blood flow, not increased ammonia uptake

AU - Dam, Gitte

AU - Keiding, Susanne

AU - Munk, Ole L

AU - Ott, Peter

AU - Vilstrup, Hendrik

AU - Bak, Lasse Kristoffer

AU - Waagepetersen, Helle S.

AU - Schousboe, Arne

AU - Sørensen, Michael

N1 - Copyright © 2012 American Association for the Study of Liver Diseases.

PY - 2013/1

Y1 - 2013/1

N2 - Studies have shown decreased cerebral oxygen metabolism (CMRO(2)) and blood flow (CBF) in patients with cirrhosis with hepatic encephalopathy (HE). It remains unclear, however, whether these disturbances are associated with HE or with cirrhosis itself and how they may relate to arterial blood ammonia concentration and cerebral metabolic rate of blood ammonia (CMRA). We addressed these questions in a paired study design by investigating patients with cirrhosis during and after recovery from an acute episode of HE type C. CMRO(2), CBF, and CMRA were measured by dynamic positron emission tomography (PET)/computed tomography (CT). Ten patients with cirrhosis were studied during an acute episode of HE; nine were reexamined after recovery. Nine patients with cirrhosis with no history of HE served as controls. Mean CMRO(2) increased from 0.73 μmol oxygen/mL brain tissue/min during HE to 0.91 μmol oxygen/mL brain tissue/min after recovery (paired t test; P 0.30); both values were higher than in the control patients (both P

AB - Studies have shown decreased cerebral oxygen metabolism (CMRO(2)) and blood flow (CBF) in patients with cirrhosis with hepatic encephalopathy (HE). It remains unclear, however, whether these disturbances are associated with HE or with cirrhosis itself and how they may relate to arterial blood ammonia concentration and cerebral metabolic rate of blood ammonia (CMRA). We addressed these questions in a paired study design by investigating patients with cirrhosis during and after recovery from an acute episode of HE type C. CMRO(2), CBF, and CMRA were measured by dynamic positron emission tomography (PET)/computed tomography (CT). Ten patients with cirrhosis were studied during an acute episode of HE; nine were reexamined after recovery. Nine patients with cirrhosis with no history of HE served as controls. Mean CMRO(2) increased from 0.73 μmol oxygen/mL brain tissue/min during HE to 0.91 μmol oxygen/mL brain tissue/min after recovery (paired t test; P 0.30); both values were higher than in the control patients (both P

KW - Adult

KW - Aged

KW - Ammonia

KW - Blood-Brain Barrier

KW - Cerebrovascular Circulation

KW - Cerebrum

KW - Female

KW - Hepatic Encephalopathy

KW - Humans

KW - Male

KW - Middle Aged

KW - Oxygen

KW - Positron-Emission Tomography and Computed Tomography

U2 - 10.1002/hep.25995

DO - 10.1002/hep.25995

M3 - Journal article

C2 - 22886493

SN - 0270-9139

VL - 57

SP - 258

EP - 265

JO - Hepatology

JF - Hepatology

IS - 1

ER -