Biomarker-assisted identification of sepsis-related acute liver impairment: a frequent and deadly condition in critically ill patients.
APACHE
Adult
Aged
Alkaline Phosphatase
/ analysis
Bilirubin
/ analysis
Biomarkers
Cohort Studies
Comorbidity
Critical Illness
/ mortality
Female
Humans
Hyaluronic Acid
/ analysis
Intensive Care Units
International Normalized Ratio
/ methods
Liver
/ metabolism
Liver Diseases
/ mortality
Male
Middle Aged
Prognosis
ROC Curve
Sepsis
/ mortality
Serum Albumin, Human
/ analysis
biomarkers
infection
liver impairment
mortality
Journal
Clinical chemistry and laboratory medicine
ISSN: 1437-4331
Titre abrégé: Clin Chem Lab Med
Pays: Germany
ID NLM: 9806306
Informations de publication
Date de publication:
27 08 2019
27 08 2019
Historique:
received:
20
12
2018
accepted:
04
03
2019
pubmed:
6
4
2019
medline:
5
8
2020
entrez:
6
4
2019
Statut:
ppublish
Résumé
Background The prognostic impact of mild/moderate liver impairment among critically ill patients is not known. We aimed to determine whether acute liver impairment, as measured by several biomarkers, (i) is frequent, (ii) influences prognosis and (iii) to determine whether such an effect is specific for infected critically ill patients. Methods A biomarker and clinical cohort study based on a randomized controlled trial. All-cause mortality was the primary endpoint. Biomarkers hyaluronic acid (HA), bilirubin, albumin, alkaline phosphatase and the international normalized ratio (INR) were determined. Multivariable statistics were applied to estimate risk increase according to liver biomarker increase at baseline and the model was adjusted for age, APACHE II, severe sepsis/septic shock vs. milder infection, chronic alcohol abuse Charlson's co-morbidity index, cancer disease, surgical or medical patient, body mass index, sex, estimated glomerular filtration rate, mechanical ventilation and the other biomarkers. Time-to-event graphs were used. The patients were critically ill patients (n = 1096) from nine mixed medical/surgical intensive care units without known hepatobiliary disease. Results HA levels differed between infected patients (median 210.8 ng/mL [IQR: 93.2-556.6]) vs. the non-infected (median 56.8 ng/mL [IQR: 31.9-116.8], p < 0.001). Serum HA quartiles 2, 3 and 4 were independent predictors of 90-day all-cause mortality for the entire population (infected and non-infected). However, the signal was driven by the infected patients (positive interaction test, no signal in non-infected patients). Among infected patients, HA quartiles corresponded directly to the 90-day risk of dying: 1st quartile: 57/192 = 29.7%, 2nd quartile: 84/194 = 43.3%, 3rd quartile: 90/193 = 46.6%, 4th quartile: 101/192 = 52.3 %, p for trend: <0.0001. This finding was confirmed in adjusted analyses: hazard ratio vs. 1st quartile: 2nd quartile: 1.3 [0.9-1.8], p = 0.14, 3rd quartile: 1.5 [1.1-2.2], p = 0.02, 4th quartile: 1.9 [1.3-2.6], p < 0.0001). High bilirubin was also an independent predictor of mortality. Conclusions Among infected critically ill patients, subtle liver impairment, (elevated HA and bilirubin), was associated with a progressive and highly increased risk of death for the patient; this was robust to adjustment for other predictors of mortality. HA can identify patients at high risk.
Identifiants
pubmed: 30951497
doi: 10.1515/cclm-2018-1350
pii: cclm-2018-1350
doi:
Substances chimiques
Biomarkers
0
Hyaluronic Acid
9004-61-9
Alkaline Phosphatase
EC 3.1.3.1
Bilirubin
RFM9X3LJ49
Serum Albumin, Human
ZIF514RVZR
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1422-1431Commentaires et corrections
Type : CommentIn
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