Correlation Between Septic Liver Dysfunction And Carnitine Spectrum

Objective: To investigate the correlation between serum carnitine concentration and degree of liver dysfunction,severity of disease and prognosis in patients with sepsis complicated with liver dysfunction,respectively.Methods: A retrospective observational study was conducted to collect patients with sepsis complicated with liver dysfunction as the observation group,admitted to the Department of Critical Care Medicine at hospital from September 2015 to December2018(68 patients who met the inclusion criteria).A total of 50 patients who had no organ damage or failure in the general ward were selected as the control group.After admission,general information of patients was collected,and liver function indexes of observation group were collected: TBil(Total bilirubin),ALT(Alanine aminotransferase),AST(Aspartate aminotransferase).The APACHE II(Acute physiology and chronic health evaluation II)score was used to analyze the scores of patients with septic liver dysfunction within 24 hours.And then we measured and recorded the concentration of serum free carnitine(C0),acetyl carnitine(C2)and total carnitine(TC)on admission in the two groups patients.Then,to understand the 28-day survival and improvement of the observation group,we track records and improve follow-up work of the observation group,which recorded as improvement Group and death group,respectively.The difference of serum C0,C2 and TC concentrations between the observation group and the control group was statistically analyzed,as well as the correlation between carnitine spectra in the observation group and liver function indicators(TBil,ALT,AST),APACHE II score and prognosis of the disease.Results: A total of 68 patients with sepsis complicated with liver dysfunction were enrolled in the observation group,including 36 male patients(52.9%)and 32 female patients(47.1%).The patients were(38-95)years old with an average of(76±12)years old.APACHE II score:(21.65 ± 5.27)points,TBil:(49.83 ± 8.94)umol/L,ALT:(208.82± 68.44)U/L,AST:(192.49 ± 59.14)U/L.In the control group,a total of 50 general wards had no organ damage or failure,including 25 males(50%)and 25 females(50%).Their age ranged from 33 to 88 years old,with an average of(75±11)years old.There was no significant difference in age and gender between the observation group and the control group(p>0.05).The concentrations of serum C0,C2 and TC in the observation group were significantly lower than those in the control group(p<0.05).The carnitine spectrum in the observation group was significantly negatively correlated with the indicators of liver dysfunction(TBil,ALT,AST),and TBil was strongly correlated with C0(r=-0.415,p=0.00),However,the correlation with C2(r=-0.310,p=0.01)is slightly weaker than TC(r=-0.329,p=0.006).ALT and C0(r=-0.443,p=0.00)also showed a strong correlation,and also significantly higher than C2(r=-0.330,p=0.006)and TC(r=-0.305,p=0.011).The correlation between AST and C0(r=-0.426,p=0.00)is also stronger than C2(r=-0.270,p=0.026)and TC(r =-0.296,p=0.014).The concentrations of serum C0(r=-0.394,p=0.001),C2(r=-0.387,p=0.001)and TC(r=-0.392,p=0.001)were significantly negatively correlated with the APACHE II score in the observation group.And the correlation between C0,TC and APACHE II score was significantly higher than C2.According to the prognosis of patients(28-day survival rate),they were divided into two groups(30 patients with improvement and 38 patients with death).According to the prognosis of patients(28-day survival rate),they were divided into two groups(30 patients with improvement,38 patients with death),The concentration of serum C0(t=5.03,p=0.00),C2(t=3.13,p=0.00),TC(t=2.26,p=0.02)in the death group were significantly lower than those in the improvement group.Conclusion: We have analyzed the following statistical experiments to prove the following conclusions: Firstly,Sepsis with hepatic dysfunction can lead to disturbance of serum carnitine metabolism.Secondly,the serum carnitine concentration was negatively correlated with the degree of liver dysfunction and the severity of septic liver dysfunction.Thirdly,the concentration of C0,C2 and TC in serum carnitine spectrum has a predictive effect on the prognosis of patients with septic liver dysfunction.