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Implication of Hypotension in the Pathogenesis of Cognitive Impairment and Brain Injury in Chronic Liver Disease

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Abstract

The incidence of chronic liver disease is on the rise. One of the primary causes of hospital admissions for patients with cirrhosis is hepatic encephalopathy (HE), a debilitating neurological complication. HE is defined as a reversible syndrome, yet there is growing evidence stating that, under certain conditions, HE is associated with permanent neuronal injury and irreversibility. The pathophysiology of HE primarily implicates a strong role for hyperammonemia, but it is believed other pathogenic factors are involved. The fibrotic scarring of the liver during the progression of chronic liver disease (cirrhosis) consequently leads to increased hepatic resistance and circulatory anomalies characterized by portal hypertension, hyperdynamic circulatory state and systemic hypotension. The possible repercussions of these circulatory anomalies on brain perfusion, including impaired cerebral blood flow (CBF) autoregulation, could be implicated in the development of HE and/or permanent brain injury. Furthermore, hypotensive insults incurring during gastrointestinal bleed, infection, or liver transplantation may also trigger or exacerbate brain dysfunction and cell damage. This review will focus on the role of hypotension in the onset of HE as well as in the occurrence of neuronal cell loss in cirrhosis.

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Abbreviations

BBB:

Blood-brain barrier

CBF:

Cerebral blood flow

CLD:

Chronic liver disease

EC:

Endothelial cells

GI:

Gastrointestinal

HE:

Hepatic encephalopathy

LT:

Liver transplant

MAP:

Mean arterial pressure

NO:

Nitric oxide

RI:

Reperfusion injury

References

  1. Tapper EB, Parikh ND (2018) Mortality due to cirrhosis and liver cancer in the United States, 1999–2016: observational study. BMJ 362:k2817. https://doi.org/10.1136/BMJ.K2817

  2. National Center for Health Statistics Chronic Liver Disease and Cirrhosis. https://www.cdc.gov/nchs/fastats/liver-disease.htm

  3. Zhou WC, Zhang QB, Qiao L (2014) Pathogenesis of liver cirrhosis. World J Gastroenterol 20:7312–7324. https://doi.org/10.3748/wjg.v20.i23.7312

    Article  CAS  Google Scholar 

  4. Ochoa-Sanchez R, Rose CF (2018) Pathogenesis of hepatic Encephalopathy in Chronic Liver Disease. J Clin Exp Hepatol 8:262–271. https://doi.org/10.1016/j.jceh.2018.08.001

    Article  Google Scholar 

  5. Shifflet A, Wu GY (2009) Non-alcoholic steatohepatitis: an overview. J Formos Med Assoc 108:4–12

    Article  Google Scholar 

  6. Bataller R, Brenner DA (2005) Liver fibrosis. J Clin Invest 115:209–218. https://doi.org/10.1172/JCI24282

    Article  CAS  Google Scholar 

  7. Yang L, Yang C, Thomes PG et al (2019) Lipophagy and alcohol-induced fatty liver. Front Pharmacol 10:495. https://doi.org/10.3389/fphar.2019.00495

  8. Parola M, Pinzani M (2019) Liver fibrosis: pathophysiology, pathogenetic targets and clinical issues. Mol Aspects Med 65:37–55

    Article  CAS  Google Scholar 

  9. Gustot T, Stadlbauer V, Laleman W et al (2021) Transition to decompensation and acute-on-chronic liver failure: role of predisposing factors and precipitating events. J Hepatol 75:S36–S48. https://doi.org/10.1016/j.jhep.2020.12.005

    Article  Google Scholar 

  10. Poordad FF (2015) Presentation and complications associated with cirrhosis of the liver. Curr Med Res Opin 31:925–937

    Article  Google Scholar 

  11. Tsoris A, Marlar C (2020) Use Of The Child Pugh Score In Liver Disease. In: StatPearls. [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. 2022 Mar 18. https://www.ncbi.nlm.nih.gov/books/NBK542308/

  12. Shah NJ, Mousa OY, Syed K, et al. Acute On Chronic Liver Failure. [Updated 2022 Oct 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499902/

  13. Arroyo V, Moreau R, Jalan R (2020) Acute-on-Chronic Liver Failure. 382:2137-2145 https://doi.org/10.1056/NEJMra1914900

  14. Moreau R, Jalan R, Gines P et al (2013) Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology 144:1426–1437e9. https://doi.org/10.1053/j.gastro.2013.02.042

    Article  Google Scholar 

  15. Weissenborn K (2019) Hepatic encephalopathy: definition, clinical Grading and Diagnostic Principles. Drugs 79:5–9

    Article  Google Scholar 

  16. Labenz C, Toenges G, Schattenberg JM et al (2019) Health-related quality of life in patients with compensated and decompensated liver cirrhosis. Eur J Intern Med 70:54–59. https://doi.org/10.1016/j.ejim.2019.09.004

    Article  Google Scholar 

  17. Dhiman RK, Sawhney MS, Chawla YK et al (2000) Efficacy of lactulose in cirrhotic patients with subclinical hepatic encephalopathy. Dig Dis Sci 45:1549-52. https://doi.org/10.1023/a:1005556826152

  18. Allampati S, Duarte-Rojo A, Thacker LR et al (2016) Diagnosis of minimal hepatic Encephalopathy using Stroop EncephalApp: a multicenter US-Based, norm-based study. Am J Gastroenterol 111:78–86. https://doi.org/10.1038/ajg.2015.377

    Article  Google Scholar 

  19. Afzal S, Ahmad M (2011) Precipitating factors of Hepatic Coma. Annals of KEMU 7:213.

  20. Romero-Gómez M, Jover M, Galán JJ, Ruiz A (2009) Gut ammonia production and its modulation. Metab Brain Dis 24:147–157. https://doi.org/10.1007/s11011-008-9124-3

    Article  CAS  Google Scholar 

  21. Litwack G (2018) Chap. 13- metabolism of amino acids. Human biochemistry. Academic Press, pp 359–394

  22. Ahluwalia V, Betrapally NS, Hylemon PB et al (2016) Impaired gut-liver-brain Axis in patients with cirrhosis. Sci Rep 6:26800. https://doi.org/10.1038/srep26800

  23. Bosoi CR, Rose CF (2009) Identifying the direct effects of ammonia on the brain. Metab Brain Dis 25:95–102. https://doi.org/10.1142/7114

    Article  Google Scholar 

  24. Rose C, Felipo V (2005) Limited capacity for ammonia removal by brain in chronic liver failure: potential role of nitric oxide. Metab Brain Dis 20:275–283. https://doi.org/10.1007/s11011-005-7906-4

    Article  CAS  Google Scholar 

  25. Sepehrinezhad A, Zarifkar A, Namvar G et al (2020) Astrocyte swelling in hepatic encephalopathy: molecular perspective of cytotoxic edema. Metab Brain Dis. https://doi.org/10.1007/s11011-020-00549-8

    Article  Google Scholar 

  26. Leite MC, Brolese G, de Almeida LMV et al (2006) Ammonia-induced alteration in S100B secretion in astrocytes is not reverted by creatine addition. Brain Res Bull 70:179–185. https://doi.org/10.1016/j.brainresbull.2006.05.003

    Article  CAS  Google Scholar 

  27. Brusilow SW, Koehler RC, Traystman RJ, Cooper AJL (2010) Astrocyte glutamine synthetase: Importance in Hyperammonemic Syndromes and potential target for Therapy. Neurotherapeutics 7:452–470. https://doi.org/10.1016/j.nurt.2010.05.015

    Article  CAS  Google Scholar 

  28. Cichoz-Lach H, Michalak A (2013) Current pathogenetic aspects of hepatic encephalopathy and noncirrhotic hyperammonemic encephalopathy. World J Gastroenterol 19:26–34. https://doi.org/10.3748/wjg.v19.i1.26

    Article  Google Scholar 

  29. Butterworth RF (2008) Pathophysiology of hepatic encephalopathy: the concept of synergism. Hepatol Res 38:S116-21 https://doi.org/10.1111/j.1872-034X.2008.00436.x.

  30. Bajaj JS, Schubert CM, Heuman DM et al (2010) Persistence of cognitive impairment after resolution of overt hepatic encephalopathy. Gastroenterology 138:2332–2340. https://doi.org/10.1053/j.gastro.2010.02.015

    Article  Google Scholar 

  31. Agarwal AN, Mais DD (2019) Sensitivity and specificity of Alzheimer type II astrocytes in hepatic encephalopathy. Arch Pathol Lab Med 143:1256–1258. https://doi.org/10.5858/arpa.2018-0455-OA

    Article  CAS  Google Scholar 

  32. Zeneroli ML, Cioni G, Vezzelli C et al (1987) Prevalence of brain atrophy in liver cirrhosis patients with chronic persistent encephalopathy. Evaluation by computed tomography. J Hepatol 4:283–292. https://doi.org/10.1016/S0168-8278(87)80536-6

    Article  CAS  Google Scholar 

  33. Albhaisi SAM, Bajaj JS (2020) Cognitive function in liver transplantation. Curr Transpl Rep 7:31–37. https://doi.org/10.1007/s40472-020-00274-2

    Article  Google Scholar 

  34. Weiss N, Thabut D (2019) Neurological complications occurring after liver transplantation: role of risk factors, hepatic Encephalopathy, and Acute (on Chronic) Brain Injury. Liver Transpl 25:469–487. https://doi.org/10.1002/lt.25420

    Article  Google Scholar 

  35. Dhar R, Young GB, Marotta P (2008) Perioperative neurological complications after liver transplantation are best predicted by pre-transplant hepatic encephalopathy. Neurocrit Care 8:253–258. https://doi.org/10.1007/s12028-007-9020-4

    Article  Google Scholar 

  36. García-Lezana T, Oria M, Romero-Giménez J et al (2017) Cerebellar neurodegeneration in a new rat model of episodic hepatic encephalopathy. J Cereb Blood Flow Metab 37:927–937. https://doi.org/10.1177/0271678X16649196

    Article  Google Scholar 

  37. Ochoa-Sanchez R, Tamnanloo F, Rose CF (2021) Hepatic encephalopathy: from metabolic to neurodegenerative. Neurochem Res 46:2612-2625 https://doi.org/10.1007/s11064-021-03372-4

    Article  CAS  Google Scholar 

  38. Granger DN, Kvietys PR (2004) Circulation, overview. Encyclopedia of Gastroenterology. Elsevier, pp 351–355

  39. Buob S, Johnston AN, Webster CRL (2011) Portal hypertension: pathophysiology, diagnosis, and treatment. J Vet Intern Med 25:169–186

    Article  CAS  Google Scholar 

  40. Kumar A, Praveen S, Sarin S (2008) Hepatic venous pressure gradient measurement:time to learn! Indian J Gastroenterol 27:74–80

    Google Scholar 

  41. Groszmann RJ, Wongcharatrawee S (2004) The hepatic venous pressure gradient: anything worth doing should be done right. Hepatology 39:280–282

    Article  Google Scholar 

  42. McConnell M, Iwakiri Y (2018) Biology of portal hypertension. Hepatol Int 12:11–23

    Article  Google Scholar 

  43. Jairath V, Desborough MJR (2015) Modern-day management of upper gastrointestinal haemorrhage. Transfus Med 25:351–357. https://doi.org/10.1111/tme.12266

    Article  CAS  Google Scholar 

  44. Vora RS, Subramanian RM (2019) Hypotension in cirrhosis. Clin Liver Dis (Hoboken) 13:149–153

    Article  Google Scholar 

  45. Iwakiri Y, Groszmann RJ (2006) The Hyperdynamic Circulation of Chronic Liver Diseases: From the Patient to the Molecule. Hepatology 43:S121-31 https://doi.org/10.1002/hep.20993

  46. Tarquini R, Masini E, LaVilla G et al (2009) Increased plasma Carbon Monoxide in patients with viral cirrhosis and hyperdynamic circulation. Am J Gastroenterol 104:891–897. https://doi.org/10.1038/ajg.2009.2

    Article  CAS  Google Scholar 

  47. García-Pagán JC, Gracia-Sancho J, Bosch J (2012) Functional aspects on the pathophysiology of portal hypertension in cirrhosis. J Hepatol 57:458–461. https://doi.org/10.1016/j.jhep.2012.03.007

    Article  Google Scholar 

  48. Vilar Gomez E, Torres Gonzalez A, Calzadilla Bertot L et al (2014) Arterial blood pressure is closely related to ascites development in compensated HCV-related cirrhosis. PLoS ONE 9:e95736. https://doi.org/10.1371/journal.pone.0095736

  49. Fernandez-Seara J, Prieto J, Quiroga J et al (1989) Systemic and regional hemodynamics in patients with liver cirrhosis and ascites with and without functional renal failure. Gastroenterology 97:1304–1312. https://doi.org/10.1016/0016-5085(89)91704-6

    Article  CAS  Google Scholar 

  50. Salerno F, Gerbes A, Ginès P et al (2008) Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis. Postgrad Med J 84:662–670

    Article  Google Scholar 

  51. Ruiz-Del-Arbol L, Serradilla R (2015) Cirrhotic cardiomyopathy. World J Gastroenterol 21:11502–11521. https://doi.org/10.3748/wjg.v21.i41.11502

    Article  CAS  Google Scholar 

  52. Pere P, Höckerstedt K, Isoniemi H, Lindgren L (2000) Cerebral blood flow and oxygenation in liver transplantation for acute or chronic hepatic disease without venovenous bypass. Liver Transpl 6:471–479. https://doi.org/10.1053/jlts.2000.8186

    Article  CAS  Google Scholar 

  53. de Oliveira THC, Marques PE, Proost P, Teixeira MMM (2018) Neutrophils: a cornerstone of liver ischemia and reperfusion injury. Lab Invest 98:51–62. https://doi.org/10.1038/labinvest.2017.90

    Article  CAS  Google Scholar 

  54. Bañares R, Bañares B, Moitinho E et al (1999) Carvedilol, a New Nonselective Beta-Blocker with intrinsic Anti-Alpha 1-Adrenergic activity. Has a Greater Portal Hypotensive Effect Than Propranolol in Patients With Cirrhosis. Hepatology 1999 30:79-83 https://doi.org/10.1002/hep.510300124

  55. Tripathi D, Hayes PC (2014) Beta-blockers in portal hypertension: new developments and controversies. Liver Int 34:655–667. https://doi.org/10.1111/liv.12360

    Article  CAS  Google Scholar 

  56. Leithead JA, Hayes PC, Ferguson JW (2014) Review article: advances in the management of patients with cirrhosis and portal hypertension-related renal dysfunction. Aliment Pharmacol Ther 39:699–711

    Article  CAS  Google Scholar 

  57. Garcia-Tsao G (2001) Current management of the complications of cirrhosis and portal hypertension: Variceal hemorrhage, ascites, and spontaneous bacterial peritonitis. Gastroenterology 120:726–748. https://doi.org/10.1053/gast.2001.22580

    Article  CAS  Google Scholar 

  58. Duschek S, Schandry R (2007) Reduced brain perfusion and cognitive performance to constitutional hypotension. Clin Auton Res 17:69–76

    Article  Google Scholar 

  59. Morris M, Scherr P, Hebert L et al (2002) Association between blood pressure and cognitive function in a Biracial Community Population of older persons. Neuroepidemiology 21:123–130

    Article  Google Scholar 

  60. Lécuyer M-AA, Kebir H, Prat A (2016) Glial influences on BBB functions and molecular players in immune cell trafficking. 1862:472–482

  61. Finnerty FA, Witkins L, Fazekas JF (1954) Cerebral hemodynamics during cerebral ischemia induced by acute hypotension. J Clin Invest 33:1227–1232. https://doi.org/10.1172/JCI102997

    Article  Google Scholar 

  62. Armstead WM (2016) Cerebral blood Flow Autoregulation and Dysautoregulation. Anesthesiol Clin 34:465–477

    Article  Google Scholar 

  63. Berne RM, Winn HR, Rubio R (1981) The Local Regulation of Cerebral Blood Flow. Prog Cardiovasc Dis 24:243-60. https://doi.org/0.1016/0033-0620(81)90030-x

  64. Peterson EC, Wang Z, Britz G (2011) Regulation of cerebral blood flow. Int J Vasc Med 2011:823525. https://doi.org/10.1155/2011/823525

  65. Duschek S, Schandry R (2007) Reduced brain perfusion and cognitive performance due to constitutional hypotension. Clin Auton Res 17:69–76. https://doi.org/10.1007/s10286-006-0379-7

    Article  Google Scholar 

  66. Frederiksen SD, Haanes KA, Warfvinge K, Edvinsson L (2019) Perivascular neurotransmitters: regulation of cerebral blood flow and role in primary headaches. J Cereb Blood Flow Metab 39:610–632

    Article  CAS  Google Scholar 

  67. Ogoh S (2017) Relationship between cognitive function and regulation of cerebral blood flow. J Physiological Sci 67:345–351. https://doi.org/10.1007/s12576-017-0525-0

    Article  Google Scholar 

  68. Koehler RC, Roman RJ, Harder DR (2009) Astrocytes and the regulation of cerebral blood flow. Trends Neurosci 32:160–169

    Article  CAS  Google Scholar 

  69. Trewby PN, Williams R (1977) Pathophysiology of hypotension in patients with fulminant hepatic failure. Gut 18:1021–1026. https://doi.org/10.1136/gut.18.12.1021

    Article  CAS  Google Scholar 

  70. Brady KM, Hudson A, Hood R et al (2020) Personalizing the definition of hypotension to protect the brain. Anesthesiology 132:170–179. https://doi.org/10.1097/ALN.0000000000003005

    Article  Google Scholar 

  71. Grace PA (1994) Ischemia-reperfusion injury. Br J Surg 81:631–641

    Google Scholar 

  72. Morrison H, McKee D, Ritter L (2011) Systemic neutrophil activation in a mouse model of ischemic stroke and reperfusion. Biol Res Nurs 13:154–163. https://doi.org/10.1177/1099800410384500

    Article  Google Scholar 

  73. Ito D, Tanaka K, Suzuki S et al (2001) Enhanced expression of Iba1, Ionized calcium-binding adapter molecule 1, after transient focal cerebral ischemia in rat brain. Stroke 32:1208–1215

    Article  CAS  Google Scholar 

  74. L’Ecuyer S, Gilbert K, Brochu B et al (2021) Targeting Uric Acid prevents Brain Injury and anxiety in a rat model of hemorrhagic shock. Shock 56:298–307. https://doi.org/10.1097/SHK.0000000000001708

    Article  CAS  Google Scholar 

  75. Nemirovich-Danchenko NM, Khodanovich MY (2019) New neurons in the post-ischemic and injured brain: migrating or resident? Front Neurosci 13:588

  76. Moretti R, Torre P, Antonello RM et al (2008) Risk factors for vascular dementia: hypotension as a key point. Vasc Health Risk Manag 4:395–402. https://doi.org/10.2147/VHRM.S2434

    Article  Google Scholar 

  77. Mccarron RM, Yu Z-Y, Ono S, Spatz M (2002) Effect of hemorrhagic shock on apoptosis and energy-dependent Efflux System in the brain. Neurochem Res 27:1625–1632

    Article  Google Scholar 

  78. Puig B, Brenna S, Magnus T (2018) Molecular communication of a dying neuron in stroke. Int J Mol Sci 19:2834. https://doi.org/10.3390/ijms19092834

  79. Nour M, Scalzo F, Liebeskind DS (2013) Ischemia-Reperfusion Injury in Stroke. Interv Neurol 1:185–199. https://doi.org/10.1159/000353125

    Article  Google Scholar 

  80. Lochhead JJ, McCaffrey G, Quigley CE et al (2010) Oxidative stress increases blood-brain barrier permeability and induces alterations in occludin during hypoxia-reoxygenation. J Cereb Blood Flow Metab 30:1625–1636. https://doi.org/10.1038/jcbfm.2010.29

    Article  CAS  Google Scholar 

  81. Frøkjær VG, Strauss GI, Mehlsen J et al (2006) Autonomic dysfunction and impaired cerebral autoregulation in cirrhosis. Clin Auton Res 16:208–216. https://doi.org/10.1007/s10286-006-0337-4

    Article  Google Scholar 

  82. Larsen FS, Olsen KS, Ejlersen E et al (1995) Cerebral blood flow autoregulation and transcranial doppler sonography in patients with cirrhosis. Hepatology 22:730–736. https://doi.org/10.1016/0270-9139(95)90290-2

    Article  CAS  Google Scholar 

  83. Bjerring PN, Gluud LL, Larsen FS (2018) Cerebral blood Flow and metabolism in hepatic Encephalopathy—A Meta-analysis. J Clin Exp Hepatol 8:286–293. https://doi.org/10.1016/j.jceh.2018.06.002

    Article  Google Scholar 

  84. Henriksen JH, Moller S (2006) Liver cirrhosis and arterial hypertension. World J Gastroenterol 12:678–685

    Article  CAS  Google Scholar 

  85. Toyoda K, Fujii K, Ibayashi S et al (1997) Role of nitric oxide in regulation of brain stem circulation during hypotension. J Cereb Blood Flow Metab 17:1089–1096. https://doi.org/10.1097/00004647-199710000-00011

    Article  CAS  Google Scholar 

  86. Hendrickse M, Triger D (1992) Peripheral and cardiovascular autonomic impairment in chronic liver disease: prevalence and relation to hepatic function. J Hepatol 16:177–183

    Article  CAS  Google Scholar 

  87. Tzamouranis DG, Alexopoulou A, Dourakis SP, Stergiou GS (2010) Relationship of 24-hour ambulatory blood pressure and heart rate with markers of hepatic function in cirrhotic patients. BMC Gastroenterol 10:143. https://doi.org/10.1186/1471-230X-10-143

  88. Merli M, Nicolini G, Angeloni S et al (2003) Incidence and natural history of small esophageal varices in cirrhotic patients. J Hepatol 38:266–272. https://doi.org/10.1016/S

    Article  Google Scholar 

  89. Benigni A, Boccardo P, Galbusera M et al (1993) Reversible activation defect of the platelet glycoprotein IIb-IIIa Complex in Patients With Uremia Am J Kidney Dis 22:668-76. https://doi.org/10.1016/s0272-6386(12)80429-x.

  90. Alam I, Haider I, Humayun M et al(2005) Spectrum of precipitating factors of hepatic encephalopathy in liver cirrhosis.Pakistan J Med Res44

  91. Mumtaz K, Ahmed U, Abid S et al (2010) Precipitating factors and the Outcome. of Hepatic Encephalopathy in Liver Cirrhosis. J Coll Physicians Surg Pak 20:514-8.

  92. Olde Damink SWM, Dejong CHC, Deutz NEP, Soeters PB (1997) Effects of simulated Upper Gastrointestinal Hemorrhage on Ammonia and related amino acids in blood and. Brain of Chronic Portacaval-shunted Rats. Metab Brain Dis 12:121-35

  93. Strnad P, Tacke F, Koch A, Trautwein C (2017) Liver-guardian, modifier and target of sepsis. Nat Rev Gastroenterol Hepatol 14:55–66

    Article  CAS  Google Scholar 

  94. Bajaj JS, Heuman DM, Hylemon PB et al (2014) Altered profile of human gut microbiome is associated with cirrhosis and its complications. J Hepatol 60:940–947. https://doi.org/10.1016/j.jhep.2013.12.019

    Article  CAS  Google Scholar 

  95. Ghosh G, Jesudian AB (2019) Small intestinal bacterial overgrowth in patients with cirrhosis. J Clin Exp Hepatol 9:257–267. https://doi.org/10.1016/j.jceh.2018.08.006

    Article  Google Scholar 

  96. Wong F, Bernardi M, Balk R et al (2005) Sepsis in cirrhosis: report on the 7th meeting of the International Ascites Club. Gut 54:718–725. https://doi.org/10.1136/gut.2004.038679

  97. Mattos AA, Wiltgen D, Jotz RF et al (2020) Spontaneous bacterial peritonitis and extraperitoneal infections in patients with cirrhosis. Ann Hepatol 19:451–457. https://doi.org/10.1016/j.aohep.2020.04.010

    Article  CAS  Google Scholar 

  98. Sipeki N, Antal-Szalmas P, Lakatos PL, Papp M (2014) Immune dysfunction in cirrhosis. World J Gastroenterol 20:2564–2577. https://doi.org/10.3748/wjg.v20.i10.2564

    Article  CAS  Google Scholar 

  99. Guarner C, Soriano G (2005) Bacterial translocation and its consequences in patients with liver cirrhosis. Eur J Gastroenterol Hepatol 17:27–31

    Article  CAS  Google Scholar 

  100. Navasa M, Rodés J (2004) Bacterial infections in cirrhosis. Liver Int 24:277–280. https://doi.org/10.1111/j.1478-3231.2004.0934.x

    Article  Google Scholar 

  101. Sharshar T, Gray F, Poron F et al (2002) Multifocal necrotizing leukoencephalopathy in septic shock. Crit Care Med 30:2371–2375. https://doi.org/10.1097/00003246-200210000-00031

    Article  CAS  Google Scholar 

  102. Rose CF, Amodio P, Bajaj JS et al (2020) Hepatic encephalopathy: novel insights into classification, pathophysiology and therapy. J Hepatol 73:1526–1547. https://doi.org/10.1016/j.jhep.2020.07.013

    Article  Google Scholar 

  103. Thooft A, Favory R, Salgado DR et al (2011) Effects of changes in arterial pressure on organ perfusion during septic shock. Crit Care 15:5–12. https://doi.org/10.1186/cc10462

    Article  Google Scholar 

  104. Sonneville R, Verdonk F, Rauturier C et al (2013) Understanding brain dysfunction in sepsis. Ann Intensive Care 3:1–11. https://doi.org/10.1186/2110-5820-3-15

    Article  Google Scholar 

  105. Hofer S, Bopp C, Hoerner C et al (2008) Injury of the blood brain barrier and Up-Regulation of ICAM-1 in Polymicrobial Sepsis. J Surg Res 146:276–281. https://doi.org/10.1016/j.jss.2007.07.021

    Article  CAS  Google Scholar 

  106. Schuppan D, Afdhal NH (2008) Liver cirrhosis. The Lancet 371:838–851. https://doi.org/10.1016/S0140-6736(08)60383-9

    Article  CAS  Google Scholar 

  107. Lee H-C, Ryu H-G, Jung C-W (2017) Performance measurement of intraoperative systolic arterial pressure to predict in-hospital mortality in adult liver transplantation OPEN. 7:7030. https://doi.org/10.1038/s41598-017-07664-0

  108. Joosten A, Lucidi V, Ickx B et al (2021) Intraoperative hypotension during liver transplant surgery is associated with postoperative acute kidney injury: a historical cohort study. BMC Anesthesiol 21:1–10. https://doi.org/10.1186/s12871-020-01228-y

    Article  Google Scholar 

  109. Gregory A, Stapelfeldt WH, Khanna AK et al (2021) Intraoperative hypotension is Associated with adverse clinical outcomes after noncardiac surgery. Anesth Analg 132:1654–1665. https://doi.org/10.1213/ANE.0000000000005250

    Article  CAS  Google Scholar 

  110. Feltracco P, Brezzi ML, Barbieri S et al (2013) Blood loss, predictors of bleeding, transfusion practice and strategies of blood cell salvaging during liver transplantation. World J Hepatol 5:1–15. https://doi.org/10.4254/wjh.v5.i1.1

    Article  Google Scholar 

  111. Donohue CI, Mallett S, v, Perioperative RF (2015) Reducing transfusion requirements in liver transplantation. World J Transplant 5:165–182. https://doi.org/10.5500/wjt.v5.i4.165

    Article  Google Scholar 

  112. Carrier FM, Sylvestre MP, Massicotte L et al (2020) Effects of intraoperative hemodynamic management on postoperative acute kidney injury in liver transplantation: an observational cohort study. PLoS ONE 15. https://doi.org/10.1371/journal.pone.0237503

  113. Philips BJ, Armstrong IR, Pollock A, Alistair L (1998) Cerebral blood flow and metabolism in patients with chronic liver disease undergoing orthotopic liver transplantation. Hepatology 27:369–376. https://doi.org/10.1002/hep.510270209

    Article  CAS  Google Scholar 

  114. Dar WA, Sullivan E, Bynon JS et al (2019) Ischaemia reperfusion injury in liver transplantation: Cellular and molecular mechanisms. Liver Int 39:788–801. https://doi.org/10.1111/liv.14091

    Article  Google Scholar 

  115. Novak V, Novak P, Spies J, Low P (1998) Autoregulation of cerebral blood Flow in Orthostativ Hypotension. Stroke 21:104–111. https://doi.org/10.1016/B978-0-12-802381-5.00011-7

    Article  Google Scholar 

  116. Felipo V, Urios A, Montesinos E et al (2012) Contribution of hyperammonemia and inflammatory factors to cognitive impairment in minimal hepatic encephalopathy. Metab Brain Dis 27:51–58. https://doi.org/10.1007/s11011-011-9269-3

    Article  CAS  Google Scholar 

  117. Zheng G, Lu H, Yu W et al (2017) Severity-specific alterations in CBF, OEF and CMRO2 in cirrhotic patients with hepatic encephalopathy. Eur Radiol 27:4699–4709. https://doi.org/10.1007/s00330-017-4809-9

    Article  Google Scholar 

  118. Dam M, Burra P, Tedeshi U et al (1998) Regional cerebral blood flow changes in patients with cirrhosis assessed with 99mTc-HM-PAO single-photon emission computed tomography: effect of liver transplantation. J Hepatol 29:79–84

    Article  Google Scholar 

  119. Clément M, Bosoi CR, Oliveira MM et al (2021) Bile-duct ligation renders the brain susceptible to hypotension‐induced neuronal degeneration: implications of ammonia. J Neurochem 157:161-173 https://doi.org/10.1111/jnc.15290

    Article  CAS  Google Scholar 

  120. Groiss SJ, Butz M, Baumgarten TJ et al (2019) GABA-ergic tone hypothesis in hepatic encephalopathy – revisited. Clin Neurophysiol 130:911–916. https://doi.org/10.1016/j.clinph.2019.03.011

    Article  Google Scholar 

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Funding

SLE is a recipient of a Doctoral Training Scholarship from Fonds de Recherche du Québec-Santé. CFR is supported through CIHR grant..

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  1. Hepato-Neuro Laboratory, Centre de recherche du Centre Hospitalier de l’Université de Montréal (CRCHUM), 900, rue Saint-Denis - Pavillon R, R08.422 Montréal (Québec), Québec, H2X 0A9, Canada

    Sydnée L’Écuyer & Christopher F. Rose

  2. Department of Medicine, Critical Care Division, Centre Hospitalier de l’Université de Montréal, Montréal, Canada

    Emmanuel Charbonney & François Martin Carrier

  3. Department of Anesthesiology, Centre Hospitalier de l’Université de Montréal, Montréal, Canada

    François Martin Carrier

  4. Carrefour de l’innovation et santé des populations , Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montréal, Canada

    François Martin Carrier

Authors
  1. Sydnée L’Écuyer
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  2. Emmanuel Charbonney
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  3. François Martin Carrier
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  4. Christopher F. Rose
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SLE lead the work for this manuscript. All the authors contributed to the literature research, format of the review and writing of the manuscript.

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Correspondence to Christopher F. Rose.

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L’Écuyer, S., Charbonney, E., Carrier, F.M. et al. Implication of Hypotension in the Pathogenesis of Cognitive Impairment and Brain Injury in Chronic Liver Disease. Neurochem Res (2023). https://doi.org/10.1007/s11064-022-03854-z

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  • DOI: https://doi.org/10.1007/s11064-022-03854-z

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