Altered hepatocellular active transport. An early change in peritonitis.

Multiple system failure is often the final result of severe infection that cannot be controlled. The changes that may occur in remote organs and cells in the early stages of sepsis and that may initiate this process have not been defined. To study this, indocyanine green (ICG) clearance, serum enzyme levels, and reticuloendothelial (RE) function were measured during various stages of sepsis, which was produced in rats by cecal ligation and puncture (CLP). The clearance of ICG decreased significantly during the early stages of sepsis (five hours after CLP) at a time when there was no change in the serum enzyme levels or RE function. Ten hours after CLP, RE function was depressed, and serum enzyme levels were elevated. Progressive changes in RE function and serum enzyme levels occurred in the late stages of sepsis (16 hours after CLP). Since unaltered hepatic adenosine triphosphate levels have been previously found, even ten hours after CLP, humoral factor(s) may be responsible for altered ICG clearance in the early stages of sepsis. Thus, hepatocellular dysfunction occurred early in the course of sepsis and was manifested by a deficit in a plasma membrane active transport process (ICG clearance). Indocyanine green clearance provided an extremely sensitive early indication of a hepatic abnormality.