Early liver injury is closely related to organ failure of sepsis

Abstract

Backgrounds: Sepsis induced organ failure is main cause of mortality in intensive care units (ICU), however, the impact of early liver injury on clinical ending of sepsis is not clear and has not been discussed in context of clinical research on sepsis before. Our study aimed at the investigation of the clinical effect of early liver injury within 48h at ICU admission on sepsis outcomes. Methods: A single-centered, retrospective cohort of 198 adult critical patients diagnosed with sepsis were included in different ICU departments of Xiangya hospital from 2016 to 2018. Patients were divided into two groups, early liver injury and non-early liver injury within 48h at ICU admission. Baseline characteristics, clinical outcomes and risk factors of these two groups were studied. Logistic regression analysis, Cox hazard analysis, Kaplan-Meier and log-rank test were used. Results: In total, 198 patients with sepsis were included, with 106 (53.5%) with early liver injury and overall in-hospital mortality was 45.9% (n=91). Compared to non-early liver injury group, patients with early liver injury had significant higher SOFA (7.44±3.83 vs. 5.55±2.61, P<0.001), APACHE II score (15.22±23.14 vs. 9.14±8.72, P=0.013) , procalcitonin (37.10±59.20 vs. 19.24±48.10, P=0.021) , and rate of shock (63.2% vs. 48.9%, P=0.046). Primary outcome showed that early liver injury group had significant higher rate of renal dysfunction (62.3 vs. 33.7%, P<0.001), coagulation (31.1% vs. 13.0%, P=0.004) and hematologic system (72.6% vs. 52.2%, P=0.003) dysfunction hinting at higher organ failure rate. Age (OR 0.966; 95% CI 0.944-0.989; P=0.004), hypertriglyceridemia (OR 1.636; 95% CI 1.049-2.551; P=0.030), serum total bile acid (TBA, OR 1.071; 95% CI 1.030-1.113; P=0.001), hemoglobin (OR 1.030; 95% CI 1.013-1.046; P<0.001) and renal dysfunction (OR 3.403; 95% CI 1.631-7.099; P=0.001) were the independent predictors for early liver injury in sepsis by multiple regression analysis. Kaplan-Meier survival analyze demonstrated early liver injury and non-early liver injury group had similar survival time. Conclusion: Early liver injury within 48 hours on ICU admission is closely related to organ failure for patients with sepsis. Future study with big data is required to verify our viewpoint.