• Ming-Hung Tsai, Yung-Chang Chen, Jau-Min Lien, Ya-Chung Tian, Yun-Shing Peng, Ji-Tseng Fang, Chun Yang, Jui-Hsiang Tang, Yun-Yi Chu, Pang-Chi Chen, and Cheng-Shyong Wu.
• Division of Gastroenterology, Chang Gung Memorial Hospital, Chang Gung University, Taipei 105, Taiwan.
• J Crit Care. 2008 Dec 1;23(4):468-72.

BackgroundAcute liver failure is often accompanied by hyperdynamic circulation, which is also a characteristic of septic shock. Pre-existing acute liver failure may worsen the hemodynamic impairment and prognosis in sepsis.AimsTo evaluate the hemodynamic and metabolic characteristics and clinical outcomes of septic shock in patients with acute liver failure.MethodsTwenty patients with acute liver failure and 19 patients without preexisting liver disease were evaluated. Systemic hemodynamics, arterial and mixed vein blood gases, arterial lactate levels, plasma renin activity, and plasma aldosterone levels were checked during the early phase of septic shock.ResultsIn acute liver failure group, cardiac index (4.92 +/- 1.13 vs 3.69 +/- 1.06 L/min per square meter, P < .001) and oxygen delivery (604.7 +/- 139.7 vs 485.4 +/- 137.3 mL/min per square meter, P = .011) were significantly higher than those without preexisting liver diseases, while systemic vascular resistance index (1041.2 +/- 503.3 vs 1409 +/- 505.25 dyne.s/cm(5).m(2)), oxygen consumption (119.1 +/- 29.2 vs 162.4 +/- 49.4 mL/min per square meter) and oxygen extraction ratio (20% +/- 6% vs. 32% +/- 8%) were significantly higher in the latter group. Furthermore, the patients with acute liver failure had higher arterial lactate (P = .026), plasma renin activity (P = .03), plasma aldosterone levels (P < .001), and intensive care unit as well as hospital mortality rates (P = .005, and 0.02 respectively).ConclusionsIn patients with acute liver failure, septic shock was characterized by an accentuated hyperdynamic circulation, hyperlactatemia and an augmented renin-angiotensin-aldosterone system activity. Pre-existing liver failure has a significant impact on the disease severity of septic shock and portends a grave prognosis.

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