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

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

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14 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)468-472
Number of pages5
JournalJournal of Critical Care
Volume23
Issue number4
DOIs
Publication statusPublished - Dec 1 2008
Externally publishedYes

Keywords

  • Acute liver failure
  • Hemodynamics
  • Septic shock
  • Tissue oxygenation

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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  • Cite this

    Tsai, M. H., Chen, Y. C., Lien, J. M., Tian, Y. C., Peng, Y. S., Fang, J. T., Yang, C., Tang, J-H., Chu, Y. Y., Chen, P. C., & Wu, C. S. (2008). Hemodynamics and metabolic studies on septic shock in patients with acute liver failure. Journal of Critical Care, 23(4), 468-472. https://doi.org/10.1016/j.jcrc.2008.04.006