Background and aim: Liver function test (LFT) alterations in critically ill patients are frequent. The objective of the following investigation is: to describe the prevalence, patterns and clinical implications of liver function test alterations in adult patients with septic shock in ISSEMyM Medical Center.
Material and methods: Observational, retrospective study, realized from January 2016 to February 2020. Inclusion criteria: adult patients admitted in Internal Medicine and Surgery services with septic shock diagnosis, with no evidence of preexistent chronic liver disease and complete medical records. Analyzed variables: age, sex, shock etiology, LFT, concomitant diseases and outcome of the hospitalization. The “R” factor (R) was calculated to classify patients in three groups; cholestatic (R=<2), hepatocellular (R=>5), mixed pattern (R=2 to 5), an analysis per subgroup was performed.
Results: 550 clinical records were reviewed, 360 met inclusion criteria. 48.3% (n=174/360) presented LFT alterations. According to R, cholestatic pattern was predominant in 81% (n=141/174), followed by the mixed pattern with 10.3% (n=18/174) and the hepatocellular with 8.6% (n=15/174). The main etiology of septic shock was pneumonia in all three groups. On the comorbid diseases, the highest prevalence in the cholestatic group was diabetes mellitus (57.4%) and hypertension in the mixed and hepatocellular group with 72.2% (13/18) and 66.7% (10/15) respectively. Mortality rate in the group without LFT alterations was 30% (55/186), and 38% (66/174) in LFT group with alterations. In subgroup analysis, the group with the highest mortality was the mixed pattern with 11/18 deaths (61.1%), followed by the hepatocellular group with 9/15 (60%) and lastly the cholestatic with n=46/141 (42.6%).
Conclusions: LFT alterations in patients with septic shock are common; in our study, the general prevalence and predominant pattern was the cholestatic group, similar to international literature. The group with the highest mortality reported in the international literature is the hepatocellular (57%), however, in our study, hepatocellular and mixed pattern presented a similar mortality rate (60% and 61.1%, respectively).
Conflicts of interest: The authors have no conflicts of interest to declare.
