Lin Hui, Liang Qiqiang, Cai Qiqi, Huang Man
Department of General Intensive Care Unit, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310052, Zhejiang, China.
Department of General Practice, Taizhou First People's Hospital, Taizhou 318020, Zhejiang, China. Corresponding author: Huang Man, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2021 Feb;33(2):186-191. doi: 10.3760/cma.j.cn121430-20201118-00627.
To analyze the risk factors and clinical characteristics of liver injury in patients with sepsis and to provide a reference for early recognition, early diagnosis, early intervention, and improve the survival rate of patients.
The clinical data of sepsis patients admitted to the department of general intensive care unit (ICU) of the Second Affiliated Hospital of Zhejiang University School of Medicine from July 2014 to October 2020 were retrospectively analyzed. According to the occurrence of acute liver injury, patients with sepsis were divided into the liver injury group and the non-liver injury group, and the differences of demographic data, history, history of primary diseases, laboratory indicators on the first time of admission, treatments, the severity of the disease and other indicators were compared and analyzed. Logistic regression was used to analyze the risk factors for sepsis-related liver injury.
A total of 527 patients with sepsis were enrolled, and 129 patients with acute liver injury, accounting for 24.48%. Compared with the non-liver injury group, acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), pro-brain natriuretic peptide (pro-BNP), serum MB isoenzyme of creatine kinase (CK-MB), total bile acid (TBA), serum creatinine (SCr), blood urea nitrogen (BUN), lactic acid (Lac), lactate dehydrogenase (LDH), C-reactive protein (CRP), procalcitonin (PCT) in liver injury group were significantly increased [APACHE II score: 23.00±10.40 vs. 16.10±8.10, SOFA score: 9.17±4.29 vs. 5.90±3.12, pro-BNP (ng/L): 5 500.0 (1 166.0, 16 865.0) vs. 1 377.2 (448.8, 6 136.5), CK-MB (U/L): 23.0 (13.0, 55.0) vs. 18.0 (13.0, 31.0), TBA (μmol/L): 5.0 (2.4, 12.9) vs. 2.6 (1.4, 4.9), SCr (μmol/L): 146.0 (75.0, 222.0) vs. 71.0 (52.0, 125.8), BUN (mmol/L): 13.4 (8.8, 20.2) vs. 7.9 (4.9, 11.6), Lac (mmol/L): 2.0 (1.4, 4.4) vs. 1.4 (1.0, 2.2), LDH (μmol×s×L): 6.43 (3.76, 11.99) vs. 4.55 (3.38, 6.63), CRP (mg/L): 113.0 (61.8, 201.0) vs. 95.0 (37.3, 170.1), PCT (μg/L): 3.8 (1.0, 23.3) vs. 0.8 (0.2, 6.4)], prothrombin time (PT), international standard ratio (INR) and activated partial thrombin time (APTT) were significantly longer [PT (s): 19.4±7.6 vs. 16.0±4.0, INR: 1.7±1.0 vs. 1.3±0.5, APTT (s): 54.0±25.8 vs. 44.1±15.1], plasma fibrinogen (FIB), platelet count (PLT), albumin (ALB), and cholesterol (CHOL) were decreased [FIB (g/L): 4.2±2.3 vs. 4.9±1.8, PLT (×10/L): 116.3±74.3 vs. 182.7±108.6, ALB (g/L): 25.4±5.5 vs. 27.6±5.5, CHOL (mmol/L): 2.5±1.2 vs. 3.2±1.3], the probability of shock was significantly increased (91.47% vs. 59.19%), and the duration of shock was prolonged [days: 5.0 (2.0, 9.0) vs. 1.0 (0.0, 3.0)], positive rate of microbial culture (81.40% vs. 71.11%), probability of occurrence of drug-resistant bacteria (67.44% vs. 47.99%) were significantly higher, mechanical ventilation time [days: 6.0 (2.0, 12.7) vs. 2.4 (0.0, 6.9)], continuous renal replacement therapy (CRRT) time [days: 1.2 (0.0, 5.0) vs. 0.0 (0.0, 0.0)], the length of intensive care unit (ICU) stay [days: 9.0 (5.0, 18.0) vs. 7.0 (3.0, 13.0)] were significantly longer, 28-day mortality was significantly higher (80.62% vs. 28.89%), and the differences were statistically significant (all P < 0.05). Further Logistic regression analysis showed that PLT decline, PT prolongation, CRRT duration, shock duration and 28-day mortality were correlated with sepsis-related liver injury [odds ratios (OR) and 95% confidence interval (95%CI) were 0.992 (0.987-0.998), 3.103 (1.507-6.387), 1.198 (1.074-1.336), 1.196 (1.049-1.362), and 0.213 (0.072-0.633), respectively, all P < 0.05].
Prolonged PT and decreased PLT are independent risk factors for sepsis complicated with liver injury. The long duration of CRRT, long duration of shock, and high mortality are independent clinical characteristics of patients with sepsis-related liver injury.
分析脓毒症患者肝损伤的危险因素及临床特征，为早期识别、早期诊断、早期干预及提高患者生存率提供参考。
回顾性分析2014年7月至2020年10月浙江大学医学院附属第二医院综合重症监护病房（ICU）收治的脓毒症患者的临床资料。根据急性肝损伤的发生情况，将脓毒症患者分为肝损伤组和非肝损伤组，比较分析两组患者的人口学资料、病史、基础疾病史、首次入院时的实验室指标、治疗情况、疾病严重程度等指标的差异。采用Logistic回归分析脓毒症相关肝损伤的危险因素。
共纳入527例脓毒症患者，其中急性肝损伤患者129例，占24.48%。与非肝损伤组比较，肝损伤组急性生理与慢性健康状况评分系统Ⅱ（APACHEⅡ）、序贯器官衰竭评估（SOFA）、脑钠肽前体（pro-BNP）、肌酸激酶同工酶MB（CK-MB）、总胆汁酸（TBA）、血清肌酐（SCr）、血尿素氮（BUN）、乳酸（Lac）、乳酸脱氢酶（LDH）、C反应蛋白（CRP）、降钙素原（PCT）显著升高[APACHEⅡ评分：23.00±10.40比16.10±8.10，SOFA评分：9.17±4.29比5.90±3.12，pro-BNP（ng/L）：5500.0（1166.0，16865.0）比1377.2（448.8，6136.5），CK-MB（U/L）：23.0（13.0，55.0）比18.0（13.0，31.0），TBA（μmol/L）：5.0（2.4，12.9）比2.6（1.4，4.9），SCr（μmol/L）：146.0（75.0，222.0）比71.0（52.0，125.8），BUN（mmol/L）：13.4（8.8，20.2）比7.9（4.9，11.6），Lac（mmol/L）：2.0（1.4，4.4）比1.4（1.0，2.2），LDH（μmol×s×L）：6.43（3.76，11.99）比4.55（3.38，6.63），CRP（mg/L）：113.0（61.8，201.0）比95.0（37.3，170.1），PCT（μg/L）：3.8（1.0，23.3）比0.8（0.2，6.4）]，凝血酶原时间（PT）、国际标准化比值（INR）和活化部分凝血活酶时间（APTT）显著延长[PT（s）：19.4±7.6比16.0±4.0，INR：1.7±1.0比1.3±0.5，APTT（s）：54.0±25.8比44.1±15.1]，血浆纤维蛋白原（FIB）、血小板计数（PLT）、白蛋白（ALB）和胆固醇（CHOL）降低[FIB（g/L）：4.2±2.3比4.9±1.8，PLT（×10/L）：116.3±74.3比182.7±108.6，ALB（g/L）：25.4±5.5比27.6±5.5，CHOL（mmol/L）：2.5±1.2比3.2±1.3]，休克发生率显著增加（91.47%比59.19%），休克持续时间延长[天：5.0（2.0，9.0）比1.0（0.0，3.0）]微生物培养阳性率（81.40%比71.11%）、产耐药菌概率（67.44%比47.99%）显著升高，机械通气时间[天：6.0（2.0，12.7）比2.4（0.0，6.）]、持续肾脏替代治疗（CRRT）时间[天：1.2（0.0，5.0）比0.0（0.0，0.0）]、重症监护病房（ICU）住院时间[天：9.0（5.0，18.0）比7.0（3.0，13.0）]显著延长，28天死亡率显著升高（80.62%比28.89%），差异均有统计学意义（均P<0.05）。进一步Logistic回归分析显示，PLT下降、PT延长、CRRT持续时间、休克持续时间和28天死亡率与脓毒症相关肝损伤相关[比值比（OR）及95%置信区间（95%CI）分别为0.992（0.987-0.998）、3.103（1.507-6.387）、1.198（1.074-1.336）、1.196（1.049-1.362）和0.213（0.072-0.633），均P<0.05]。
PT延长和PLT降低是脓毒症合并肝损伤的独立危险因素。CRRT持续时间长、休克持续时间长和死亡率高是脓毒症相关肝损伤患者的独立临床特征。
