| Background and Objective The incidence of HA-ALI (hospital-acquired acute liver injury, HA-ALI) is increasing in critical patients year by year. It's important to analyze the cause and the risk factors obviously. It would play an active role in increasing the success rate of rescue and decreasing the morbidity, if we had controlled the risk factors of HA-ALI. The aim was to investigate the incidence and risk factors of HA-ALI in ICU, and analyze the high risk factors impacting on prognosis of the critically ill patients with HA-ALI.Methods In this retrospective study, 1623 hospitalized patients were investigated in general ICU from January 2004 to June 2009. It chose 127 critically ill patients with HA-ALI, who were with normal liver function on admission but their serum bilirubin and transaminase was increasing during hospitalization. The clinical data of 127 cases was recorded on admission, HA-ALI and discharge from hospital or death, including blood biochemical test, blood gas analysis, blood routine test and coagulation, central venous pressure (CVP), vital signs, and so on. The acute physiology and chronic health evaluation systemⅡ(APACHEⅡ) and multiple organ dysfunction syndrome (MODS)scores were evaluated. And the major therapeutic measure was recorded, such as: mechanical ventilation, continuous blood purification, operation, drugs, parenteral nutrition and diseases such as shock. The clinical index was contrasted between that on admission and HA-ALI. According to the prognosis, 127 cases were grouped as the cured group and the death group and the nonhealing group.Results 1. The general conditions: 127 patients with HA-ALI were diagnosed from 1623 cases (7.83%) in ICU.2. High risk factors of liability to HA-ALI: In 127 patients with HA-ALI, the average frequency of high risk factors was (3.4±1.1) times. Drugs, parenteral nutrition and mechanical ventilation were common susceptibility.3. The factors of influential prognosis:①Critical illness score: APACHEⅡscores in death group was significantly lower than that in the cured group on admission. When HA-ALI was occurred, MODS scores was lower than that on admission. And MODS scores were significantly lower in death group than the cure group of HA-ALI.②Ages: The age of the patients in death group was significantly higher than that in cured group and nonhealing group. There was not significant difference in other group.③The liver function on admission: The alanine aminotransferase (ALT) in death group was lower than that in the cured group and nonhealing group obviously. The activated partial thromboplastin time (APTT) was highest in death group. When HA-ALI occurred, Total protein (TP) and Globulin (GLO) in nonhealing group were significantly higher than those in the death group.④Relationship between type of ALI with prognosis: The liver cell type had 114 cases (89.76%); cholestasis type had 13 cases (10.24%); mixed type had 0. There was not difference among three groups.4. Cardiopulmonary resuscitation, shock and the use of sedatives and narcotic drugs were regarded as the independent risk factors.Conclusion 1. The incidence of the HA-ALI was 7.83% in the critically ill patients.2. Lots of pathogenic factors played a part in HA-ALI commonly. The more treatment critically ill patients accepted, the more HA-ALI was.3. The liver cell type was common in HA-ALI,which was 89.76%.The elderly patients had poor prognosis. APACHEⅡand MODS scores were not able to judge their prognosis accurately.4. Cardiopulmonary resuscitation, shock, and the use of sedatives and narcotic drugs were regarded as the independent risk factors in the patients with HA-ALI in ICU. |
