{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T20:22:37Z","timestamp":1774642957821,"version":"3.50.1"},"reference-count":54,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2014,4,29]],"date-time":"2014-04-29T00:00:00Z","timestamp":1398729600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100003141","name":"Consejo Nacional de Ciencia y Tecnolog\u00eda","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100003141","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2015,2]]},"abstract":"Abstract<\/jats:title>Background & Aims<\/jats:title>Factors other than elevated levels of ammonia may be implicated in hepatic encephalopathy (HE<\/jats:styled-content>) pathophysiology, including abnormal cerebral haemodynamics. Transcranial Doppler ultrasonography (TCD<\/jats:styled-content>) evaluates cerebrovascular structural integrity and reactivity, through pulsatility index (PI<\/jats:styled-content>) and breath\u2010holding index (BHI<\/jats:styled-content>) respectively. The aim of this study was to evaluate cerebral haemodynamics by TCD<\/jats:styled-content> in patients with compensated and decompensated cirrhosis, and patients with and without HE<\/jats:styled-content>.<\/jats:p><\/jats:sec>Methods<\/jats:title>We studied 90 subjects by TCD<\/jats:styled-content> measuring PI<\/jats:styled-content> and BHI<\/jats:styled-content> in the middle cerebral artery: 30 with cirrhosis and no HE<\/jats:styled-content>, 30 with cirrhosis and low\u2010grade HE<\/jats:styled-content> and 30 healthy subjects. Critical flicker frequency, psychometric hepatic encephalopathy score and West\u2010Haven criteria were performed to assess MHE<\/jats:styled-content> and HE<\/jats:styled-content> respectively.<\/jats:p><\/jats:sec>Results<\/jats:title>Pulsatility index increased in decompensated cirrhotics (Child\u00a0\u2265\u00a07) when compared with compensated cirrhotics and healthy subjects [median (IQR) 1.07 (0.95\u20131.21) vs 0.90 (0.83\u20131.05) vs 0.87 (0.78\u20130.96); P<\/jats:italic>\u00a0<\u00a00.001]. A reverse relationship was observed for BHI<\/jats:styled-content> among the three groups [0.82 (0.45\u20131.11) vs 1.20 (0.82\u20131.52) vs 1.28 (1.06\u20131.68); P<\/jats:italic>\u00a0<\u00a00.001]. Similar findings were observed in decompensation [model for end\u2010stage liver disease (MELD<\/jats:styled-content>) score \u226514]. Patients with HE<\/jats:styled-content> showed higher PI<\/jats:styled-content> and lower BHI<\/jats:styled-content> [1.05 (1.00\u20131.16) and 0.89 (0.59\u20131.15)], when compared with patients without HE<\/jats:styled-content> [0.96 (0.83\u20131.13) and 1.00 (0.60\u20131.53)] or controls [0.87 (0.78\u20130.96) and 1.28 (1.06\u20131.68)] (P<\/jats:italic>\u00a0<\u00a00.001 for PI<\/jats:styled-content>, and P<\/jats:italic>\u00a0=\u00a00.007 for BHI<\/jats:styled-content>). In multivariate regression models, only PI<\/jats:styled-content> predicted HE<\/jats:styled-content>, but it was outperformed by MELD<\/jats:styled-content>\u2010sodium and tumour necrosis factor\u2010alpha.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>These results indicate that cerebral haemodynamics are altered in patients with cirrhosis, in relation to severity of disease and HE<\/jats:styled-content>. Findings on impaired PI<\/jats:styled-content> and BHI<\/jats:styled-content> suggest that structural vascular damage and loss of vascular autoregulation are implicated in the pathophysiology of HE<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.12557","type":"journal-article","created":{"date-parts":[[2014,4,2]],"date-time":"2014-04-02T01:12:50Z","timestamp":1396401170000},"page":"344-352","source":"Crossref","is-referenced-by-count":30,"title":["Cerebral haemodynamics in cirrhotic patients with hepatic encephalopathy"],"prefix":"10.1111","volume":"35","author":[{"given":"Ricardo U.","family":"Mac\u00edas\u2010Rodr\u00edguez","sequence":"first","affiliation":[{"name":"Liver Clinic Department of Gastroenterology Instituto Nacional de Ciencias M\u00e9dicas y Nutrici\u00f3n \u201cSalvador Zubir\u00e1n\u201d M\u00e9xico D.F Tlalpan M\u00e9xico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andr\u00e9s","family":"Duarte\u2010Rojo","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology University of Arkansas for Medical Sciences (UAMS) Little Rock AR USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlos","family":"Cant\u00fa\u2010Brito","sequence":"additional","affiliation":[{"name":"Department of Neurology Instituto Nacional de Ciencias M\u00e9dicas y Nutrici\u00f3n \u201cSalvador Zubir\u00e1n\u201d M\u00e9xico D.F Tlalpan M\u00e9xico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tilman","family":"Sauerbruch","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I University of Bonn Bonn Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Astrid","family":"Ruiz\u2010Marg\u00e1in","sequence":"additional","affiliation":[{"name":"Liver Clinic Department of Gastroenterology Instituto Nacional de Ciencias M\u00e9dicas y Nutrici\u00f3n \u201cSalvador Zubir\u00e1n\u201d M\u00e9xico D.F Tlalpan M\u00e9xico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonel","family":"Trebicka","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I University of Bonn Bonn Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marina","family":"Green\u2010G\u00f3mez","sequence":"additional","affiliation":[{"name":"Liver Clinic Department of Gastroenterology Instituto Nacional de Ciencias M\u00e9dicas y Nutrici\u00f3n \u201cSalvador Zubir\u00e1n\u201d M\u00e9xico D.F Tlalpan M\u00e9xico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorge B.","family":"D\u00edaz Ram\u00edrez","sequence":"additional","affiliation":[{"name":"Department of Neurology Instituto Nacional de Ciencias M\u00e9dicas y Nutrici\u00f3n \u201cSalvador Zubir\u00e1n\u201d M\u00e9xico D.F Tlalpan 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