Optic nerve sheath diameters predict mortality and severity in hepatic encephalopathy.

Objective: The aim of this study was to compare the predictive power of optic nerve sheath diameter (ONSD) measured by brain computed tomography (CT) in patients diagnosed with hepatic encephalopathy (HE) in the emergency department, with other factors for mortality and disease severity.

Materials and methods: A total of 217 patients aged 18 years and older with acute decompensation of cirrhosis diagnosed with HE in the emergency department were included in the study. To compare with patients diagnosed with HE, a total of 217 individuals were included in the study as the healthy control group. ONSD measurements were performed on both the HE patients and the healthy control group in the brain CT.

Results: The mortality rate of HE patients was 32.7%. Regarding the severity of the disease, 53% of the patients had late-stage HE. The presence of acute-on-chronic liver failure was detected in 51.4% of patients. The mortality rate among acute-on-chronic liver failure patients was 56.6%. According to the study data, ONSD, creatinine, lactate, and procalcitonin were independent predictors of mortality. Meanwhile, Child-Pugh score, direct bilirubin, ONSD, ammonia, and total bilirubin were independent predictors of disease severity. In the receiver operating characteristic curve analysis, the ONSD had the highest predictive power for mortality and disease severity among the determined predictive values.

Conclusion: The data from the study suggests that assessing the ONSD through brain CT scans in individuals diagnosed with HE in the emergency department may provide valuable insights for clinicians, aiding in the prediction of both mortality rates and the severity of the disease.