The summaries are free for public
use. The Chronic Liver Disease
Foundation will continue to add and
archive summaries of articles deemed
relevant to CLDF by the Board of
Trustees and its Advisors.
Abstract Details
Treating hepatic encephalopathy in cirrhotic patients admitted to ICU with sodium phenylbutyrate: a preliminary study
Weiss N1,2,3,4,5,6,7,8, Tripon S1,2,3,4,5,6,7,8, Lodey M, Guiller E, Junot H, Monneret D1,2,3,4,5,6,7,8, Mayaux J, Brisson H, Mallet M1,2,3,4,5,6,7,8, Rudler M1,2,3,4,5,6,7,8, Imbert-Bismut F1,2,3,4,5,6,7,8, Thabut D1,4; Brain-Liver Pitié-Salpêtrière Study Group (BLIPS). Fundam Clin Pharmacol. 2017 Dec 14. doi: 10.1111/fcp.12340. [Epub ahead of print]
Author information
1
Brain-Liver Pitié-Salpêtrière Study Group (BLIPS), Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris & INSERM UMR_S 938, CDR Saint-Antoine & Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France.
2
Sorbonne Universités, UPMC Univ Paris 06 & Unité de réanimation neurologique, Département de Neurologie, Pôle des maladies du système nerveux, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.
3
Institut de Neurosciences Translationnelles de Paris, Institut-Hospitalo-Universitaire-A-Institut du Cerveau et de la Moelle (IHU-A-ICM), Paris, France.
4
Soins Intensifs d'Hépatologie, Service d'Hépato-Gastroentérologie, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.
5
Service de pharmacie, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.
6
Service de biochimie, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.
7
Unité de Réanimation et de Surveillance continue, Service de Pneumologie et Réanimation médicale, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.
8
Service de réanimation, Département d'anesthésie-réanimation, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.
Abstract
Hepatic encephalopathy (HE) influences short and long-term prognosis. Recently, glycerol phenylbutyrate (PB), that lowers ammonia by providing an alternate pathway to urea for waste nitrogen excretion, has shown that it was effective in preventing the occurrence of HE in RCT. The aim was to assess the benefits of sodium PB in cirrhotic patients admitted in ICU for overt HE, in terms of ammonia levels decrease, neurological improvement and survival. Cirrhotic patients who presented with overt HE, ammonia levels >100 μmol/L, and did not display any contra-indication were included. Sodium PB was administered at 200mg/kg/day. Control group included historical controls treated by standard therapy, matched for age, sex, MELD score, and severity of HE. 18 patients were included and treated with sodium PB (age: 59 [45-68] years-old, male gender: 15 (83%), Child-Pugh B: 8 (44%), Child-Pugh C: 10 (56%) patients; MELD score: 16 [13-23]). Ammonia levels significantly decreased in the PB as compared to the control group from inclusion to 12 hours, and from inclusion to 48 hours (p=0.0201, and p=0.0230 respectively). The proportion of patients displaying neurological improvement was only higher in the PB treated group as compared to controls at ICU discharge (15 (83%) vs 9 (50%), p=0.0339). ICU discharge survival was significantly higher in patients treated with PB (17 (94%) vs 9 (50%), p=0.0017). In cirrhotic patients with overt HE, sodium PB could be effective in reducing ammonia levels, and might be effective in improving neurological status and ICU discharge survival. More extensive data, especially a RCT, are mandatory.
Stay Informed!
