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Hepatic blood flow in late sepsis patients

Abstract

Background

Systemic inflammatory response syndrome (SIRS), sepsis, and severe sepsis influence total hepatic blood flow. However there are conflicting data on the time of its assessment, methodology, study design, and differentiation in terms of whether the condition is an experimental SIRS, sepsis, or a human clinical syndrome.

Objective of the study

The aim of this study was to assess the total hepatic blood flow and the contribution of hepatic arterial blood flow (HABF) and portal venous blood flow using a Doppler vascular ultrasound in SIRS, sepsis, and severe sepsis patients, aiming at a clear prognostic parameter that can predict the patient’s outcome.

Results

There was a clear cutoff point of 16.09 ml/min for HABF, above which the hazard ratio for death was 5.6046, with a 95% confidence interval of 2.0078–15.6451 and a P-value of 0.0011 in late sepsis patients. The predictive potential for this HABF cutoff for patient mortality showed a sensitivity of 80%, specificity of 73.7%, positive predictive value of 70.6%, negative predictive value of 82.4%, 95% confidence interval of 0.612–0.907, and P-value of less than 0.0004. There was a significant positive correlation between the HABF and APACHE II scores (P= 0.023). Cox regression analysis showed that only the APACHE II score and HABF were independent predictors for patients’ outcome.

Conclusion

Duplex ultrasound assessment was a useful bedside method for predicting mortality in late sepsis patients through estimation of HABF, with a reasonable predictive potential at a definite cutoff level.

References

  1. Rudis MI, Rowland KL. Current concepts in severe sepsis and septic shock. J Pharm Pract 2005; 18:351–362.

    Article  Google Scholar 

  2. Vincent J-L, Abraham E, Annane D, Bernard G, Rivers E, Van den Berghe G. Reducing mortality in sepsis: new directions. Crit Care 2002; 6 (Suppl 3): S1–S18.

    Article  Google Scholar 

  3. Varsamidis K, Varsamidou E, Mavropoulos G. Doppler ultrasonographic evaluation of hepatic blood flow in clinical sepsis. Ultrasound Med Biol 2003; 29:1241–1244.

    Article  Google Scholar 

  4. Tadros T, Traber DL, Herndon DN. Hepatic blood flow and oxygen consumption after burn and sepsis. J Trauma 2000; 49:101–108.

    CAS  Article  Google Scholar 

  5. Spapen H. Liver perfusion in sepsis, septic shock, and multiorgan failure. Anat Rec 2008; 291:714–720.

    Article  Google Scholar 

  6. Bataar O, Lundeg G, Tsenddorj G, Jochberger S, Grander W, Baelani I, et al. Helfen Berührt Study Team. Nationwide survey on resource availability for implementing current sepsis guidelines in Mongolia. Bull World Health Organ 2010; 88:839–846.

    Article  Google Scholar 

  7. Secchi A, Ortanderl JM, Schmidt W, Gebhard MM, Martin E, Schmidt H. Effect of endotoxemia on hepatic portal and sinusoidal blood flow in rats. J Surg Res 2000; 89:26–30.

    CAS  Article  Google Scholar 

  8. Pastor CM, Suter PM. Hepatic hemodynamics and cell functions in human and experimental sepsis. Anesth Analg 1999; 89:344–352.

    CAS  PubMed  Google Scholar 

  9. Dahn MS, Lange MP, Wilson RF, Jacobs LA, Mitchell RA. Hepatic blood flow and splanchnic oxygen consumption measurements in clinical sepsis. Surgery 1990; 107:295–301.

    CAS  PubMed  Google Scholar 

  10. Wang P, Zheng FBA, Chaudry IH. Increase in hepatic blood flow during early sepsis is due to increased portal blood flow. Am J Physiol 1991; 261:R1507–R1512.

    CAS  PubMed  Google Scholar 

  11. Sakka SG, Reinhart K, Meier-Hellmann A. Does the optimization of cardiac output by fluid loading increase splanchnic blood flow? Br J Anaesth 2001; 86:657–662.

    CAS  Article  Google Scholar 

  12. Carroll GC, Snyder JV. Hyperdynamic severe intravascular sepsis depends on fluid administration in cynomolgus monkey. Am J Physiol 1982; 243:R131–R141.

    CAS  PubMed  Google Scholar 

  13. Lang CH, Bagby CJ, Ferguson JL, Spitzer JJ. Cardiac output and redistribution of organ blood flow in hypermetabolic sepsis. Am J Physiol 1984; 246:R331–R337.

    CAS  PubMed  Google Scholar 

  14. Gottlieb ME, Sarfeh IJ, Stratton H, Goldman ML, Newell JC, Shah DM. Hepatic perfusion and splanchnic oxygen consumption in patients postinjury. J Trauma 1983; 23:836–843.

    CAS  Article  Google Scholar 

  15. Meier-Hellmann A, Reinhart K, Bredle DL, Specht M, Spies CD, Hannemann L. Epinephrine impairs splanchnic perfusion in septic shock. Crit Care Med 1997; 25:399–404.

    CAS  Article  Google Scholar 

  16. Burton-Opitz R. The vascularity of the liver: the influence of the portal blood flow upon the flow in the hepatic artery. Q J Exp Physiol 1911; 4:93–102.

    Article  Google Scholar 

  17. Lautt WW. Role and control of the hepatic artery. In: Lautt WW, editor. Hepatic circulation in health and disease. New York: Raven Press; 1981. pp. 203–226.

    Google Scholar 

  18. Lautt WW, Legare DJ, Ezzat WR. Quantitation of the hepatic arterial buffer response to graded changes in portal blood flow. Gastroenterology 1990; 98:1024–1028.

    CAS  Article  Google Scholar 

  19. Jakab F, Ráth Z, Schmal F, Nagy P, Faller J. The interaction between hepatic arterial and portal venous blood flows; simultaneous measurement by transit time ultrasonic volume flowmetry. Hepatogastroenterology 1995; 42:18–21.

    CAS  PubMed  Google Scholar 

  20. Ayuse T, Brienza N, Revelly JP, O’Donnell CP, Boitnott JK, Robotham JL. Alterations in liver hemodynamics in an intact porcine model of endotoxin shock. Am J Physiol 1995; 268:H1106– H1114.

    CAS  PubMed  Google Scholar 

  21. Cryer HM, Unger LS, Garrison RN, Harris PD. Prostaglandins maintain renal microvascular blood flow during hyperdynamic bacteremia. Circ Shock 1988; 26:71–88.

    CAS  PubMed  Google Scholar 

  22. Ring A, Stremmel W. The hepatic microvascular responses to sepsis. Semin Thromb Hemost 2000; 26:589–594.

    CAS  Article  Google Scholar 

  23. Spronk PE, Zandstra DF, Ince C. Bench-to-bedside review: sepsis is a disease of the microcirculation. Crit Care 2004; 8:462–468.

    Article  Google Scholar 

  24. Avontuur JAM, Boomsma F, van den Meiracker AH, de Jong FH, Bruining HA. Endothelin-1 and blood pressure after inhibition of nitric oxide synthesis in human septic shock. Circulation 1999; 99:271–275.

    CAS  Article  Google Scholar 

  25. Bone RC. The pathogenesis of sepsis. Ann Intern Med 1991; 115: 457–469.

    CAS  Article  Google Scholar 

  26. Ince C, Sinaasappel M. Microcirculatory oxygenation and shunting in sepsis and shock. Crit Care Med 1999; 27:1369–1377.

    CAS  Article  Google Scholar 

  27. Uusaro A, Ruokonen E, Takala J. Estimation of splanchnic blood flow by the Fick principle in man and problems in the use of indocyanine green. Cardiovasc Res 1995; 30:106–112.

    CAS  Article  Google Scholar 

  28. Schönhofer B, Guo JJ, Suchi S, Köhler D, Lefering R. The use of APACHE II prognostic system in difficult-to-wean patients after long-term mechanical ventilation. Eur J Anaesthesiol 2004; 21:558–565.

    Article  Google Scholar 

  29. Sakr Y, Krauss C, Amaral AC, Re´a-Neto A, Specht M, Reinhart K, Marx G. Comparison of the performance of SAPS II, SAPS 3, APACHE II, and their customized prognostic models in a surgical intensive care unit. Br J Anaesth 2008; 101:798–803.

    CAS  Article  Google Scholar 

  30. Quach S, Hennessy DA, Faris P, Fong A, Quan H, Doig C. A comparison between the APACHE II and Charlson Index Score for predicting hospital mortality in critically ill patients. BMC Health Serv Res 2009; 129:1–8.

    Google Scholar 

  31. Mbongo CL, Monedero P, Guillen-Grima F, Yepes MJ, Vives M, Echarri G. Performance of SAPS3, compared with APACHE II and SOFA, to predict hospital mortality in a general ICU in Southern Europe. Eur J Anaesthesiol 2009; 26:940–945.

    Article  Google Scholar 

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Correspondence to Abir Zakaria.

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El Maqsoud, A.A., Zakaria, A. & Shoukry, F. Hepatic blood flow in late sepsis patients. Egypt J Intern Med 25, 15–19 (2013). https://doi.org/10.7123/01.EJIM.0000425955.92493.b0

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  • DOI: https://doi.org/10.7123/01.EJIM.0000425955.92493.b0

Keywords

  • hepatic arterial blood flow
  • portal venous blood flow
  • sepsis
  • total hepatic blood flow Egypt J Intern Med 25:15–19