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

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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.

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Notes

  1. The New Royal Infirmary, Edinburgh

  2. The New Royal Infirmary, Edinburgh

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Acknowledgement

We are grateful to Dr A LeeFootnote 1 and Prof P C HayesFootnote 2 for their help with this study.

Disclosures

None of the authors of this manuscript have any competing interests to declare.

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Authors and Affiliations

  1. Liver Failure Group, The Institute of Hepatology, Division of Medicine, University College London, 69-75 Chenies Mews, London, WC1E 6H, UK

    Gavin Wright, Debbie Shawcross & Rajiv Jalan

  2. Department of Surgery, Academic Hospital, Maastricht, The Netherlands

    Steven W. M. Olde Damink

Authors
  1. Gavin Wright
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  2. Debbie Shawcross
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  3. Steven W. M. Olde Damink
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  4. Rajiv Jalan
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Correspondence to Rajiv Jalan.

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Wright, G., Shawcross, D., Olde Damink, S.W.M. et al. Brain cytokine flux in acute liver failure and its relationship with intracranial hypertension. Metab Brain Dis 22, 375–388 (2007). https://doi.org/10.1007/s11011-007-9071-4

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