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Metabolic Brain Disease

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01-12-2007 | ORIGINAL PAPER

Brain cytokine flux in acute liver failure and its relationship with intracranial hypertension

Authors: Gavin Wright, Debbie Shawcross, Steven W. M. Olde Damink, Rajiv Jalan

Published in: Metabolic Brain Disease | Issue 3-4/2007

Abstract

Background

In acute liver failure (ALF), it is unclear whether the systemic inflammatory response associated with intracranial hypertension is related to brain cytokine production.

Aim

To determine the relationship of brain cytokine production with severity of intracranial hypertension in ALF patients.

Method

We studied 16 patients with ALF. All patients were mechanically ventilated and cerebral blood flow measured using the Kety–Schmidt technique and intracranial pressure (ICP) measured with a Camino subdural catheter. We sampled blood from an artery and a reverse jugular catheter to measure proinflammatory cytokines (TNF-α, IL-6 and IL-1β) and ammonia. Additionally, in 3 patients, serial samples were obtained over a 72 h period.

Results

In ALF patients a good correlation between arterial pro-inflammatory cytokines and ICP (r ² = 0.34, 0.50 and 0.52; for IL-6, IL-1β and TNF-α respectively) was observed. There was a positive cerebral cytokine ‘flux’ (production), in ALF patients with uncontrolled ICP. Plasma ammonia between groups was not statistically significant. In the ALF patients studied longitudinally, brain proinflammatory cytokine production was associated with uncontrolled ICP.

Conclusion

Our results provide novel data supporting brain production of cytokines in patients with uncontrolled intracranial hypertension indicating activation of the inflammatory cascade in the brain. Also, the appearance of these cytokines in the jugular bulb catheter may indicate a compromised blood brain barrier at this late stage.

The New Royal Infirmary, Edinburgh

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Title: Brain cytokine flux in acute liver failure and its relationship with intracranial hypertension
Authors: Gavin Wright
Debbie Shawcross
Steven W. M. Olde Damink
Rajiv Jalan
Publication date: 01-12-2007
Publisher: Springer US
Published in: Metabolic Brain Disease / Issue 3-4/2007
Print ISSN: 0885-7490
Electronic ISSN: 1573-7365
DOI: https://doi.org/10.1007/s11011-007-9071-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Brain cytokine flux in acute liver failure and its relationship with intracranial hypertension

Abstract

Background

Aim

Method

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Aim

Method

Results

Conclusion

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