Hemodynamics and metabolic studies on septic shock in patients with acute liver failure

Tsai, Ming-Hung; Chen, Yung-Chang; Lien, Jau-Min; Tian, Ya-Chung; Peng, Yun-shing; Fang, Ji-Tseng; Yang, Chun; Tang, Jui-Hsiang; Chu, Yun-Yi; Chen, Pang-Chi; Wu, Cheng-Shyong

doi:10.1016/j.jcrc.2008.04.006

« Previous Next »Journal of Critical Care
Volume 23, Issue 4 , Pages 468-472, December 2008

Hemodynamics and metabolic studies on septic shock in patients with acute liver failure☆

Ming-Hung Tsai
- Division of Gastroenterology, Chang Gung Memorial Hospital, Chang Gung University, Taipei 105, Taiwan
Yung-Chang Chen
- Division of Critical Care Nephrology, Chang Gung Memorial Hospital, Chang Gung University, Taipei 105, Taiwan
Jau-Min Lien
- Division of Gastroenterology, Chang Gung Memorial Hospital, Chang Gung University, Taipei 105, Taiwan
Ya-Chung Tian
- Division of Critical Care Nephrology, Chang Gung Memorial Hospital, Chang Gung University, Taipei 105, Taiwan
Yun-shing Peng
- Department of Internal Medicine, Chang Gung Memorial Hospital, Chia-Yi 613, Taiwan
Ji-Tseng Fang
- Division of Critical Care Nephrology, Chang Gung Memorial Hospital, Chang Gung University, Taipei 105, Taiwan
Chun Yang
- Division of Gastroenterology, Chang Gung Memorial Hospital, Chang Gung University, Taipei 105, Taiwan
Jui-Hsiang Tang
- Division of Gastroenterology, Chang Gung Memorial Hospital, Chang Gung University, Taipei 105, Taiwan
Yun-Yi Chu
- Division of Gastroenterology, Chang Gung Memorial Hospital, Chang Gung University, Taipei 105, Taiwan
Pang-Chi Chen
- Division of Gastroenterology, Chang Gung Memorial Hospital, Chang Gung University, Taipei 105, Taiwan
Cheng-Shyong Wu
- Division of Gastroenterology, Chang Gung Memorial Hospital, Chang Gung University, Pu-Tz City, Chia-Yi 613, Taiwan
- Corresponding author. Tel.: +886 5 3621000x2005; fax: +886 3 3288662.

Abstract

Backgrounds

Acute liver failure is often accompanied by hyperdynamic circulation, which is also a characteristic of septic shock. Pre-existing acute liver failure may worsen the hemodynamic impairment and prognosis in sepsis.

Aims

To evaluate the hemodynamic and metabolic characteristics and clinical outcomes of septic shock in patients with acute liver failure.

Methods

Twenty patients with acute liver failure and 19 patients without preexisting liver disease were evaluated. Systemic hemodynamics, arterial and mixed vein blood gases, arterial lactate levels, plasma renin activity, and plasma aldosterone levels were checked during the early phase of septic shock.

Results

In acute liver failure group, cardiac index (4.92 ± 1.13 vs 3.69 ± 1.06 L/min per square meter, P < .001) and oxygen delivery (604.7 ± 139.7 vs 485.4 ± 137.3 mL/min per square meter, P = .011) were significantly higher than those without preexisting liver diseases, while systemic vascular resistance index (1041.2 ± 503.3 vs 1409 ± 505.25 dyne·s/cm⁵·m²), oxygen consumption (119.1 ± 29.2 vs 162.4 ± 49.4 mL/min per square meter) and oxygen extraction ratio (20% ± 6% vs. 32% ± 8%) were significantly higher in the latter group. Furthermore, the patients with acute liver failure had higher arterial lactate (P = .026), plasma renin activity (P = .03), plasma aldosterone levels (P < .001), and intensive care unit as well as hospital mortality rates (P = .005, and 0.02 respectively).

Conclusions

In patients with acute liver failure, septic shock was characterized by an accentuated hyperdynamic circulation, hyperlactatemia and an augmented renin-angiotensin-aldosterone system activity. Pre-existing liver failure has a significant impact on the disease severity of septic shock and portends a grave prognosis.

Keywords: Hemodynamics, Tissue oxygenation, Septic shock, Acute liver failure