Continuous Electroencephalography in Acute Liver Failure: Findings and Prognostic Value

Continuous Electroencephalography in Acute Liver Failure: Findings and Prognostic Value | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Continuous Electroencephalography in Acute Liver Failure: Findings and Prognostic Value Denise Fay Chen, Mirza Farrque, Ioannis Karakis, Navnika Gupta, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4608462/v2 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 07 Feb, 2025 Read the published version in Neurocritical Care → Version 2 posted 4 You are reading this latest preprint version Show more versions Abstract Background and Objectives: Neurologic complications contribute significantly to morbidity and mortality in acute liver failure (ALF). However, clinical assessment of neurologic function in this population is often challenging. Continuous electroencephalography (cEEG) is a low-risk, noninvasive diagnostic tool which can monitor real-time cerebral function. We aimed to investigate cEEG findings and prognostic significance of specific EEG features in a cohort of strictly defined ALF patients. Methods: This was a retrospective, single-center study of adult patients with ALF who underwent cEEG monitoring for at least 6 hours between 2013 and 2022. Clinical, laboratory, imaging, and treatment characteristics were evaluated. cEEG variables included background continuity, background frequency, the presence of sporadic epileptiform discharges, rhythmic or periodic patterns, and electrographic or electroclinical seizures. The primary outcome was mortality or transition to end-of-life care during the index admission. Results: A total of 32 patients with ALF were included. 56.3% of patients had rhythmic or periodic patterns, of which the majority were generalized periodic discharges (GPDs, 37.5%). 12.5% of patients had sporadic epileptiform discharges and 6.3% of patients demonstrated electrographic or clinical seizures. Eighteen (56.3%) patients died or were transitioned to end-of-life care during the index admission. Worsening background continuity or frequency over the course of the cEEG recording was significantly associated with poor outcome (p=0.001, p = 0.007, respectively), with a 100% mortality rate in patients demonstrating these EEG trends. A worst recorded continuity of suppression, attenuation, burst-suppression, and burst-suppression, was also associated with poor outcome (p=0.012). The presence of rhythmic or periodic patterns, sporadic epileptiform discharges, or seizures was not predictive of outcome. Conclusions: Worsening cEEG background continuity or frequency is associated with poor outcome in adults with ALF. cEEG may contribute useful prognostic information in these patients, in conjunction with other laboratory and clinical markers of disease severity. Full Text Cite Share Download PDF Status: Published Journal Publication published 07 Feb, 2025 Read the published version in Neurocritical Care → Version 2 posted Editorial decision: Accept as is 12 Jan, 2025 Editor invited by journal 08 Jan, 2025 Editor assigned by journal 08 Jan, 2025 First submitted to journal 07 Jan, 2025 You are reading this latest preprint version Show more versions Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4608462","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":401108724,"identity":"ccd4967a-ad84-4d6a-95d8-1bb57baf8c19","order_by":0,"name":"Denise Fay Chen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAn0lEQVRIiWNgGAWjYDCCwwfYgKQNmC1BnJZjCSAtaaRrOUyCFr5jzM8efNxxPnHDAeaDt3mI0SJ5jM3ccOaZ20AtbMnWRGkxuN/DJs3bdjtx2wEeM2nitBzjYZP+23YOqIX/GwlaGNsOgGxhI04L0C9mkr1tycb7D7MZW84hRgsoxCR+ttnJzmxvfnjjDTFaEICZNOWjYBSMglEwCvABABRIMfDGdKSFAAAAAElFTkSuQmCC","orcid":"https://orcid.org/0000-0002-9827-3351","institution":"University of Washington School of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Denise","middleName":"Fay","lastName":"Chen","suffix":""},{"id":401108725,"identity":"092b42c0-abea-43d8-b354-7484c1003ea9","order_by":1,"name":"Mirza Farrque","email":"","orcid":"","institution":"Emory University","correspondingAuthor":false,"prefix":"","firstName":"Mirza","middleName":"","lastName":"Farrque","suffix":""},{"id":401108726,"identity":"6218e4d1-d7f8-4202-9204-44c205fb0e67","order_by":2,"name":"Ioannis Karakis","email":"","orcid":"","institution":"Emory University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Ioannis","middleName":"","lastName":"Karakis","suffix":""},{"id":401108727,"identity":"a72c0a71-98fe-4597-a029-b3ab880f867e","order_by":3,"name":"Navnika Gupta","email":"","orcid":"","institution":"Emory University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Navnika","middleName":"","lastName":"Gupta","suffix":""},{"id":401108728,"identity":"8a716d2f-631c-4759-8fa9-5fa282d6e5d4","order_by":4,"name":"Andres Rodriguez","email":"","orcid":"","institution":"Emory University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Andres","middleName":"","lastName":"Rodriguez","suffix":""},{"id":401108729,"identity":"245db41c-4294-4f8a-99ae-b5389b867e45","order_by":5,"name":"Prem A. 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However, clinical assessment of neurologic function in this population is often challenging. Continuous electroencephalography (cEEG) is a low-risk, noninvasive diagnostic tool which can monitor real-time cerebral function. We aimed to investigate cEEG findings and prognostic significance of specific EEG features in a cohort of strictly defined ALF patients. \nMethods: This was a retrospective, single-center study of adult patients with ALF who underwent cEEG monitoring for at least 6 hours between 2013 and 2022. Clinical, laboratory, imaging, and treatment characteristics were evaluated. cEEG variables included background continuity, background frequency, the presence of sporadic epileptiform discharges, rhythmic or periodic patterns, and electrographic or electroclinical seizures. 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The presence of rhythmic or periodic patterns, sporadic epileptiform discharges, or seizures was not predictive of outcome. \nConclusions: Worsening cEEG background continuity or frequency is associated with poor outcome in adults with ALF. cEEG may contribute useful prognostic information in these patients, in conjunction with other laboratory and clinical markers of disease severity.","manuscriptTitle":"Continuous Electroencephalography in Acute Liver Failure: Findings and Prognostic Value","msid":"","msnumber":"","nonDraftVersions":[{"code":2,"date":"2025-02-06 02:26:19","doi":"10.21203/rs.3.rs-4608462/v2","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Accept as is","date":"2025-01-12T14:51:38+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"Neurocritical 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