Serial evaluation of children with ALF with advanced MRI, serum proinflammatory cytokines, thiamine, and cognition assessment

Anshu Srivastava, Santosh K. Yadav, Vibhor V. Borkar, Abhishek Yadav, Surender K. Yachha, Michael A. Thomas, Ram K.S. Rathore, Chandra M. Pandey, Rakesh K. Gupta

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

OBJECTIVES: This prospective, sequential study was done to understand changes in cerebral edema (CE) on magnetic resonance imaging and magnetic resonance spectroscopy, liver functions, and neurocognitive testing (NCT) in children with acute liver failure (ALF). METHODS: A total of 11 ALF and 8 healthy controls were evaluated with advanced magnetic resonance (MR) imaging, blood proinflammatory cytokines (PCs), thiamine levels, liver functions, and NCT. Reevaluation was done at 43.5 ± 26.9 days (first follow-up, n = 8) and 157.3 ± 52.3 days (second follow-up, n = 6) after discharge. RESULTS: At diagnosis, patients with ALF had vasogenic and cytotoxic CE, raised brain glutamine (23.2 ± 3.4 vs 15.3 ± 2.7), and serum PCs (tumor necrosis factor [TNF]-α 40.1 ± 8.9 vs 7.2 ± 2.7 pg/mL, interleukin [IL]-6 29.2 ± 14.4 vs 4.7 ± 1.2 pg/mL). The mammillary bodies (MBs) were smaller, and brain choline (1.9 ± 0.36 vs 2.6 ± 0.6) and blood thiamine (55.2 ± 6.7 vs 81.8 ± 10.2 nmol/L) were lower than controls. At first follow-up, the brain glutamine and CE recovered. Brain choline and MBs volume showed improvement and thiamine levels normalized. Significant reduction in TNF-α and IL-6 was seen. The patients performed poorly on NCT, which normalized at second follow-up. Liver biochemistry and thiamine levels were normal and TNF-α and IL-6 showed further reduction at second follow-up. CONCLUSIONS: Patients with ALF have CE contributed by raised brain glutamine and PCs. MBs are small because of thiamine deficiency and show recovery in follow-up. CE and brain glutamine recover earlier than normalization of NCT and liver functions. Persistence of raised cytokines up to 6 months after insult suggests possible contribution from liver regeneration.

Original languageEnglish
Pages (from-to)580-586
Number of pages7
JournalJournal of Pediatric Gastroenterology and Nutrition
Volume55
Issue number5
DOIs
Publication statusPublished - 1 Nov 2012
Externally publishedYes

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Acute Liver Failure
Thiamine
Brain Edema
Cognition
Cytokines
Mammillary Bodies
Glutamine
Serum
Brain
Interleukin-6
Tumor Necrosis Factor-alpha
Liver
Choline
Magnetic Resonance Imaging
Thiamine Deficiency
Liver Regeneration
Biochemistry
Magnetic Resonance Spectroscopy
Prospective Studies

Keywords

  • H-MR spectroscopy
  • Acute liver failure
  • Cerebral edema
  • Diffusion tensor imaging
  • Neuropsychological tests
  • Proinflammatory cytokines
  • Thiamine

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Gastroenterology

Cite this

Serial evaluation of children with ALF with advanced MRI, serum proinflammatory cytokines, thiamine, and cognition assessment. / Srivastava, Anshu; Yadav, Santosh K.; Borkar, Vibhor V.; Yadav, Abhishek; Yachha, Surender K.; Thomas, Michael A.; Rathore, Ram K.S.; Pandey, Chandra M.; Gupta, Rakesh K.

In: Journal of Pediatric Gastroenterology and Nutrition, Vol. 55, No. 5, 01.11.2012, p. 580-586.

Research output: Contribution to journalArticle

Srivastava, Anshu ; Yadav, Santosh K. ; Borkar, Vibhor V. ; Yadav, Abhishek ; Yachha, Surender K. ; Thomas, Michael A. ; Rathore, Ram K.S. ; Pandey, Chandra M. ; Gupta, Rakesh K. / Serial evaluation of children with ALF with advanced MRI, serum proinflammatory cytokines, thiamine, and cognition assessment. In: Journal of Pediatric Gastroenterology and Nutrition. 2012 ; Vol. 55, No. 5. pp. 580-586.
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abstract = "OBJECTIVES: This prospective, sequential study was done to understand changes in cerebral edema (CE) on magnetic resonance imaging and magnetic resonance spectroscopy, liver functions, and neurocognitive testing (NCT) in children with acute liver failure (ALF). METHODS: A total of 11 ALF and 8 healthy controls were evaluated with advanced magnetic resonance (MR) imaging, blood proinflammatory cytokines (PCs), thiamine levels, liver functions, and NCT. Reevaluation was done at 43.5 ± 26.9 days (first follow-up, n = 8) and 157.3 ± 52.3 days (second follow-up, n = 6) after discharge. RESULTS: At diagnosis, patients with ALF had vasogenic and cytotoxic CE, raised brain glutamine (23.2 ± 3.4 vs 15.3 ± 2.7), and serum PCs (tumor necrosis factor [TNF]-α 40.1 ± 8.9 vs 7.2 ± 2.7 pg/mL, interleukin [IL]-6 29.2 ± 14.4 vs 4.7 ± 1.2 pg/mL). The mammillary bodies (MBs) were smaller, and brain choline (1.9 ± 0.36 vs 2.6 ± 0.6) and blood thiamine (55.2 ± 6.7 vs 81.8 ± 10.2 nmol/L) were lower than controls. At first follow-up, the brain glutamine and CE recovered. Brain choline and MBs volume showed improvement and thiamine levels normalized. Significant reduction in TNF-α and IL-6 was seen. The patients performed poorly on NCT, which normalized at second follow-up. Liver biochemistry and thiamine levels were normal and TNF-α and IL-6 showed further reduction at second follow-up. CONCLUSIONS: Patients with ALF have CE contributed by raised brain glutamine and PCs. MBs are small because of thiamine deficiency and show recovery in follow-up. CE and brain glutamine recover earlier than normalization of NCT and liver functions. Persistence of raised cytokines up to 6 months after insult suggests possible contribution from liver regeneration.",
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AU - Yadav, Santosh K.

AU - Borkar, Vibhor V.

AU - Yadav, Abhishek

AU - Yachha, Surender K.

AU - Thomas, Michael A.

AU - Rathore, Ram K.S.

AU - Pandey, Chandra M.

AU - Gupta, Rakesh K.

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N2 - OBJECTIVES: This prospective, sequential study was done to understand changes in cerebral edema (CE) on magnetic resonance imaging and magnetic resonance spectroscopy, liver functions, and neurocognitive testing (NCT) in children with acute liver failure (ALF). METHODS: A total of 11 ALF and 8 healthy controls were evaluated with advanced magnetic resonance (MR) imaging, blood proinflammatory cytokines (PCs), thiamine levels, liver functions, and NCT. Reevaluation was done at 43.5 ± 26.9 days (first follow-up, n = 8) and 157.3 ± 52.3 days (second follow-up, n = 6) after discharge. RESULTS: At diagnosis, patients with ALF had vasogenic and cytotoxic CE, raised brain glutamine (23.2 ± 3.4 vs 15.3 ± 2.7), and serum PCs (tumor necrosis factor [TNF]-α 40.1 ± 8.9 vs 7.2 ± 2.7 pg/mL, interleukin [IL]-6 29.2 ± 14.4 vs 4.7 ± 1.2 pg/mL). The mammillary bodies (MBs) were smaller, and brain choline (1.9 ± 0.36 vs 2.6 ± 0.6) and blood thiamine (55.2 ± 6.7 vs 81.8 ± 10.2 nmol/L) were lower than controls. At first follow-up, the brain glutamine and CE recovered. Brain choline and MBs volume showed improvement and thiamine levels normalized. Significant reduction in TNF-α and IL-6 was seen. The patients performed poorly on NCT, which normalized at second follow-up. Liver biochemistry and thiamine levels were normal and TNF-α and IL-6 showed further reduction at second follow-up. CONCLUSIONS: Patients with ALF have CE contributed by raised brain glutamine and PCs. MBs are small because of thiamine deficiency and show recovery in follow-up. CE and brain glutamine recover earlier than normalization of NCT and liver functions. Persistence of raised cytokines up to 6 months after insult suggests possible contribution from liver regeneration.

AB - OBJECTIVES: This prospective, sequential study was done to understand changes in cerebral edema (CE) on magnetic resonance imaging and magnetic resonance spectroscopy, liver functions, and neurocognitive testing (NCT) in children with acute liver failure (ALF). METHODS: A total of 11 ALF and 8 healthy controls were evaluated with advanced magnetic resonance (MR) imaging, blood proinflammatory cytokines (PCs), thiamine levels, liver functions, and NCT. Reevaluation was done at 43.5 ± 26.9 days (first follow-up, n = 8) and 157.3 ± 52.3 days (second follow-up, n = 6) after discharge. RESULTS: At diagnosis, patients with ALF had vasogenic and cytotoxic CE, raised brain glutamine (23.2 ± 3.4 vs 15.3 ± 2.7), and serum PCs (tumor necrosis factor [TNF]-α 40.1 ± 8.9 vs 7.2 ± 2.7 pg/mL, interleukin [IL]-6 29.2 ± 14.4 vs 4.7 ± 1.2 pg/mL). The mammillary bodies (MBs) were smaller, and brain choline (1.9 ± 0.36 vs 2.6 ± 0.6) and blood thiamine (55.2 ± 6.7 vs 81.8 ± 10.2 nmol/L) were lower than controls. At first follow-up, the brain glutamine and CE recovered. Brain choline and MBs volume showed improvement and thiamine levels normalized. Significant reduction in TNF-α and IL-6 was seen. The patients performed poorly on NCT, which normalized at second follow-up. Liver biochemistry and thiamine levels were normal and TNF-α and IL-6 showed further reduction at second follow-up. CONCLUSIONS: Patients with ALF have CE contributed by raised brain glutamine and PCs. MBs are small because of thiamine deficiency and show recovery in follow-up. CE and brain glutamine recover earlier than normalization of NCT and liver functions. Persistence of raised cytokines up to 6 months after insult suggests possible contribution from liver regeneration.

KW - H-MR spectroscopy

KW - Acute liver failure

KW - Cerebral edema

KW - Diffusion tensor imaging

KW - Neuropsychological tests

KW - Proinflammatory cytokines

KW - Thiamine

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