Praxenthaler Janina, Schwier Elke, Altmann Simon, Kirchner Carmen, Bialas Julian, Henzler Dietrich, Köhler Thomas
Department of Anesthesiology, Surgical Intensive Care, Emergency and Pain Medicine, Ruhr-University Bochum, Klinikum Herford, 32049 Herford, Germany.
Department of Anesthesiology, Intensive Care and Pain Medicine, KSOB-Clinics, Klinikum Traunstein, 83278 Traunstein, Germany.
Biomedicines. 2022 Sep 20;10(10):2340. doi: 10.3390/biomedicines10102340.
Sepsis is often associated with liver dysfunction, which is an indicator of poor outcomes. Specific diagnostic tools that detect hepatic dysfunction in its early stages are scarce. So far, the immune modulatory effects of hemoadsorption with CytoSorb on liver function are unclear.
We assessed the hepatic function by using the dynamic LiMAx test and biochemical parameters in 21 patients with sepsis or septic shock receiving CytoSorb in a prospective, observational study. Points of measurement: T: diagnosis of sepsis or septic shock; T and T: 24 h and 48 h after the start of CytoSorb; T: 24 h after termination of CytoSorb.
The hepatic biotransformation capacity measured by LiMAx was severely impaired in up to 95 % of patients. Despite a rapid shock reversal under CytoSorb, a significant improvement in LiMAx values appeared from T to T. This decline and recovery of liver function were not reflected by common parameters of hepatic metabolism that remained mostly within the normal range.
Hepatic dysfunction can effectively and safely be diagnosed with LiMAx in ventilated ICU patients under CytoSorb. Various static liver parameters are of limited use since they do not adequately reflect hepatic dysfunction and impaired hepatic metabolism.
脓毒症常伴有肝功能障碍，这是预后不良的一个指标。目前缺乏能够在早期阶段检测肝功能障碍的特异性诊断工具。到目前为止，细胞吸附柱（CytoSorb）血液吸附对肝功能的免疫调节作用尚不清楚。
在一项前瞻性观察性研究中，我们对21例接受细胞吸附柱治疗的脓毒症或脓毒性休克患者，使用动态利马唑（LiMAx）试验和生化参数评估其肝功能。测量时间点：T：脓毒症或脓毒性休克诊断时；T₁和T₂：开始使用细胞吸附柱后24小时和48小时；T₃：停止使用细胞吸附柱后24小时。
通过LiMAx测量的肝脏生物转化能力在高达95%的患者中严重受损。尽管在细胞吸附柱治疗下休克迅速逆转，但从T₁到T₃，LiMAx值有显著改善。肝功能的这种下降和恢复并未被大多仍在正常范围内的肝脏代谢常见参数所反映。
在接受细胞吸附柱治疗的通气重症监护病房患者中，LiMAx能够有效且安全地诊断肝功能障碍。各种静态肝脏参数的作用有限，因为它们不能充分反映肝功能障碍和肝脏代谢受损情况。
