Tang Zhi-Qiang, Zhao Dan-Ping, Dong A-Jing, Li Hai-Bo
Intensive Care Unit, The Second Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China.
World J Clin Cases. 2023 Sep 26;11(27):6515-6522. doi: 10.12998/wjcc.v11.i27.6515.
Non-liquefied multiple liver abscesses (NMLA) can induce sepsis, septic shock, sepsis-associated kidney injury (SA-AKI), and multiple organ failure. The inability to perform ultrasound-guided puncture and drainage to eradicate the primary disease may allow for the persistence of bacterial endotoxins and endogenous cytokines, exacerbating organ damage, and potentially causing immunosuppression and T-cell exhaustion. Therefore, the search for additional effective treatments that complement antibiotic therapy is of great importance.
A 45-year-old critically ill female patient presented to our hospital's intensive care unit with intermittent vomiting, diarrhea, and decreased urine output. The patient exhibited a temperature of 37.8 °C. Based on the results of liver ultrasonography, laboratory tests, fever, and oliguria, the patient was diagnosed with NMLA, sepsis, SA-AKI, and immunosuppression. We administered antibiotic therapy, entire care, continuous renal replacement therapy (CRRT) with an M100 hemofilter, and hemoperfusion (HP) with an HA380 hemofilter. The aforementioned treatment resulted in a substantial reduction in disease severity scores and a decrease in the extent of infection and inflammatory factors. In addition, the treatment stimulated the expansion of the cluster of differentiation 8 (CD8) T-cells and led to the complete recovery of renal function. The patient was discharged from the hospital. During the follow-up period of 28 d, she recovered successfully.
Based on the entire therapeutic regimen, the early combination of CRRT and HP therapy may control sepsis caused by NMLA and help control infections, reduce inflammatory responses, and improve CD8 T-cell immune function.
非液化性多发性肝脓肿（NMLA）可诱发脓毒症、感染性休克、脓毒症相关性肾损伤（SA-AKI）和多器官功能衰竭。无法进行超声引导下穿刺引流以根除原发性疾病可能会使细菌内毒素和内源性细胞因子持续存在，加剧器官损伤，并可能导致免疫抑制和T细胞耗竭。因此，寻找补充抗生素治疗的其他有效治疗方法非常重要。
一名45岁危重症女性患者因间歇性呕吐、腹泻和尿量减少入住我院重症监护病房。患者体温为37.8℃。根据肝脏超声检查结果、实验室检查、发热和少尿情况，该患者被诊断为NMLA、脓毒症、SA-AKI和免疫抑制。我们给予抗生素治疗、综合护理、使用M100血液滤过器进行持续肾脏替代治疗（CRRT）以及使用HA380血液滤过器进行血液灌流（HP）。上述治疗使疾病严重程度评分大幅降低，感染和炎症因子程度减轻。此外，该治疗刺激了分化簇8（CD8）T细胞的扩增，并导致肾功能完全恢复。患者出院。在28天的随访期内，她成功康复。
基于整个治疗方案，早期联合CRRT和HP治疗可能控制NMLA引起的脓毒症，并有助于控制感染、减轻炎症反应以及改善CD8 T细胞免疫功能。
