23. Role of trans-cranial Doppler in children with acute liver failure – A prospective observational pilot study

Abstract

Background and Aims: Early detection of raised intracranial pressure improves outcome in acute liver failure (ALF). We evaluated role of bedside transcranial doppler (TCD) in ALF children for feasibility, correlation with severity of hepatic encephalopathy (HE) and predicting outcome. Methods: 28 ALF children [24 boys, 11 (5–18 years)] with HE (grade I–II = 9, III–IV = 19) and 47 healthy controls [30 boys, 11 (5–18 years)] were prospectively enrolled. Demographic, clinical and laboratory parameters were recorded. Expert radiologist performed TCD of middle cerebral artery (MCA) with 2 MHz probe through temporal window. Peak systolic velocity (Vs), end diastolic velocity (Vd), mean flow velocity (mFV), pulsatility (PI) and resistive index (RI) were calculated by electronic calipers. PI ≥ 1.2 was suggestive of raised ICP. Results: TCD could be performed in all patients and healthy controls except one with poor window. TCD parameters in controls and ALF with grade I–II HE and III–IV HE are shown in Table 1. The peak systolic velocity, PI and RI showed an increasing trend from controls to HE grade I–II to grade III–IV (Table 1). ALF children with HE grade III–IV had significantly higher peak systolic velocity, PI and RI as compared to controls. However, the difference in peak systolic velocity, PI and RI in ALF patients with HE grade I-II versus controls and ALF with HE I-II versus III-IV was not statistically significant. ALF children with PI ≥ 1.2 (n = 7) more often had severe grade (III-IV) of HE (7/7 vs. 12/21; p = 0.03) and poorer outcome (0/7 vs. 8/21 survival without transplantation; p = 0.05) than those with PI < 1.2 (n = 21). Conclusions: Transcranial doppler is feasible in ALF children. The PI, RI and peak systolic velocity of MCA are higher in ALF with grade III-IV HE then controls but they do not differentiate between grades of HE. PI ≥ 1.2 is a predictor of poor outcome. The authors have none to declare.