Risk Factors And Prognosis Of Sepsis-associated Liver Injury

ObjectiveTo explore and analyze risk factors and prognostic factors for sepsis-associated liver injury.MethodsThe data of 146 septic patients admitted between January 2014 and December 2016 in Department of Intensive Care Unit,the First Affiliated Hospital of Dalian Medical University were analyzed retrospectively.The septic patients were divided into liver injury group and normal liver function group based on presence or absence of liver injury.Multiple factors logistic regression analysis was used to evaluate the high risk factors for sepsis-associated liver injury.According to the clinical outcome the liver injury group was divided into two subgroups:survival group and death group,and analyzed the related prognosis.The liver injury group was also divided into three subgroups,including high glutamic-pyruvic transaminase group,high bilirubin group,high bilirubin and glutamic-pyruvic transaminase group,and analyzed prognosis of patients.Results1.146 patients were enrolled,including 93 cases accounted for 63.70%of male and 53 females accounted for 36.30%,68 patients(46.58%)in liver injury group,78 patients(53.42%)in normal liver function group,and sepsis-associated liver injury incidence of 46.58%.2.Single factor analysis found sex,age,smoking,alcoholism,hypertension,cerebrovascular disease,coronary heart disease,chronic obstructive pulmonary disease(COPD),chronic kidney disease,chronic cardiac insufficiency,blood glucose(Glu)and puncture catheter were no statistical difference(P>0.05).There were significant difference in diabetes mellitus[DM,45.59%(31/68)vs 29.49%(23/78)],mechanical ventilation[91.18%(62/68)vs 75.64%(59/78)],blood lactate[Lac,1.70(1.13,2.98)mmol/L vs 1.30(1.00,2.25)mmol/L],procalcitonin[PCT,0.79(0.15,3.68)?g/L vs 0.25(0.10,1.14)?g/L],sequential organ failure assessment(SOFA)scoring system(7.37±3.46 vs 4.95±2.63),acute physiology and chronic health evaluation II(APACHE?)score(19.22±7.24 vs 16.04±6.41)between the injury group and normal liver function group(P<0.05).3.On the basis of multiple factors logistic regression analysis,the differences of DM[odds ratio(OR)=3.283,95%confidence interval(95%CI)= 1.385?7.781,P =0.007]and SOFA scoring system(OR = 1.493,95%CI = 1.196?1.863,P = 0.000)were statistically significant.4.Compared with normal liver function group,the mortality[35.29%(24/68)vs 19.23%(15/78)],ICU duration[18(12,30)d vs 16(10,22)d],mechanical ventilation duration[15(8,25)d vs 7(0,13)d]and the morbidity of multple organ dysfunction syndrome(MODS)[54.41%(37/68)vs 34.62%(27/78)]were significantly increased in liver injury group(both P<0.05).5.Single factor analysis,between the death subgroup and survival subgroup of liver injury group,continuous renal replacement therapy[CRRT,33.33%(8/24)vs 9.09%(4/44)],PCT[1.72(0.46,33.60)?g/L vs 0.49(0.14,1.30)pg/L],the number of organ dysfunction[3(3,3)vs 1(0,2)],APACHE ? score[24.00(12.50,27.75)vs 19.00(13.00,21.75)],Lac2[1.85(1.43,2.68)mmol/L vs 1.55(1.10,2.05)mmol/L]when the liver injury appeared were statistically difference(P<0.05).On the basis of multiple factors logistic regression analysis,PCT(OR = 1.167,95%CI = 1.002?1.360,P=0.046)and the number of organ dysfunction(OR = 11.444,95%CI= 2.385?54.917,P=0.002)were statistically difference between two subgroups(P<0.05).6.Liver injury patients began to involve in liver dysfunction from the first day to the forty-ninth day after sepsis identified,and median was the fourth day.The duration of liver injury in ICU was range from 2 d to 46 d,and median day was 9 d.There were 60 cases(88.24%)with high glutamic-pyruvic transaminase level and 23 cases(33.82%)with abnormally high bilirubin level in the liver injury group.7.The mortality of the three liver injury subgroups was 28.89%(13/45),50,00%(4/8),46.67%(7/15)respectively,and there was no significant difference(P>0.05).The recovery rate of liver function was the highest in septic patients with high glutamic-pyruvic transaminase level[68.89%(31/45)],and the lowest in septic patients with abnormally high bilirubin level[25.00%(2/8)],and there was significant difference(P<0.05).The incidence of MODS was 42.22%(19/45),75.00%(6/8),80.00%(12/15)in the three subgroups(P<0.05).There was no significant difference in ICU duration and mechanical ventilation duration among the three subgroups(P>0.05).Conclusions1.DM and high SOFA scores are high risk factors for sepsis-associated liver injury.2.Compared with the patients of normal liver function,the mortality and the morbidity of MODS are higher,and ICU duration,mechanical ventilation duration are longer in liver injury group.3.PCT value and the number of organ dysfunction are the higher,and the prognosis of liver injury patients is poorer.4.Liver injury usually occurs in the early stage of sepsis.The patients with liver injury often show high glutamic-pyruvic transaminase level.5.The incidence of MODS is highest and the recovery rate of liver function is the lowest in septic patients with abnormaly high bilirubin level.