Hepatic Perfusion Alterations in Septic Shock Patients: Impact of Early Goal-directed Therapy

Xi-Wen Zhang, Jian-Feng Xie, Ai-Ran Liu, Ying-Zi Huang, Feng-Mei Guo, Cong-Shan Yang, Yi Yang, Hai-Bo Qiu, Xi-Wen Zhang, Jian-Feng Xie, Ai-Ran Liu, Ying-Zi Huang, Feng-Mei Guo, Cong-Shan Yang, Yi Yang, Hai-Bo Qiu

Abstract

Background: Early goal-directed therapy (EGDT) has become an important therapeutic management in early salvage stage of septic shock. However, splenic organs possibly remained hypoperfused and hypoxic despite fluid resuscitation. This study aimed to evaluate the effect of EGDT on hepatic perfusion in septic shock patients.

Methods: A prospective observational study was carried out in early septic shock patients who were admitted to Intensive Care Unit within 24 h after onset and who met all four elements of the EGDT criteria after treatment with the standard EGDT procedure within 6 h between December 1, 2012 and November 30, 2013. The hemodynamic data were recorded, and oxygen metabolism and hepatic functions were monitored. An indocyanine green clearance test was applied to detect the hepatic perfusion. The patients' characteristics were compared before treatment (T0), immediately after EGDT (T1), and 24 h after EGDT (T2). This study is registered at ClinicalTrials.org, NCT02060773.

Results: Twenty-one patients were included in the study; however, the hepatic perfusion data were not included in the analysis for two patients; therefore, 19 patients were eligible for the study. Hemodynamics data, as monitored by pulse-indicator continuous cardiac output, were obtained from 16 patients. There were no significant differences in indocyanine green plasma disappearance rate (ICG-PDR) and 15-min retention rate (R15) at T0 (11.9 ± 5.0%/min and 20.0 ± 13.2%), T1 (11.4 ± 5.1%/min and 23.6 ± 14.9%), and T2 (11.0 ± 4.5%/min and 23.7 ± 15.3%) (all P > 0.05). Both of the alterations of ICG-PDR and R15 showed no differences at T0, T1, and T2 in the patients of different subgroups that achieved different resuscitation goal numbers when elected (P > 0.05).

Conclusion: There were no hepatic perfusion improvements after EGDT in the early phase of patients with septic shock.

Trial registration: Clinicaltrials.gov NCT02060773 (https://ichgcp.net/clinical-trials-registry/NCT02060773).

Figures

Figure 1
Figure 1
Overview of patient enrollment. ICU: Intensive Care Unit; EGDT: Early goal-directed therapy.
Figure 2
Figure 2
The alterations of ICG-PDR (a) and R15 (b) between T0, T1, and T2 in different subgroups which achieving different numbers of resuscitation goals. One of EGDT criteria met: n = 3; two of EGDT criteria met: n = 10; three of EGDT criteria met: n = 6. EGDT: Early goal-directed therapy; T0: Pre-EGDT; T1: Immediately after EGDT; T2: 24 h after EGDT; ICG-PDR: Indocyanine green plasma disappearance rate; R15: 15-min retention rate.
Figure 3
Figure 3
Correlations between ICG-PDR, R15, and lactate, urine output at T0 in patients with septic shock (n = 19). (a) Correlation between ICG-PDR and lactate at T0. (b) Correlation between ICG-PDR and urine output at T0. (c) Correlation between R15 and lactate at T0. (d) Correlation between R15 and urine output at T0. ICG-PDR: Indocyanine green plasma disappearance rate; R15: 15-min retention rate; Lac: Lactate.
Figure 4
Figure 4
The ROC curves of ICG-PDR and R15 for predicting the 28-day mortality rate of patients with septic shock (n = 19). (a) The ICG-PDR, ΔPDRT1–T0, ΔPDRT2-T0, and ΔPDRT2–T1 AUCs that were calculated to predict the 28-day mortality rate of patients with septic shock were 0.69 (95% CI: 0.44–0.87), 0.49 (95% CI: 0.26–0.72), 0.57 (95% CI: 0.33–0.79), and 0.66 (95% CI: 0.41–0.86). (b) The AUCs of R15, ΔR15T1–T0, ΔR15T2–T0 and ΔR15T2–T1 that were calculated to predict the 28-day mortality rate of patients with septic shock were 0.69 (95% CI: 0.44–0.87), 0.57 (95% CI: 0.33–0.79), 0.61 (95% CI: 0.36–0.82), and 0.69 (95% CI: 0.44–0.87). ROC: receiver operating characteristic; ICG-PDR: Indocyanine green plasma disappearance rate; R15: 15-min retention rate; ΔPDRT1–T0: The ICG-PDR difference between T1 and T0; ΔPDRT2–T0: The ICG-PDR difference between T2 and T0; ΔPDRT2–T1: The ICG-PDR difference between T2 and T1; ΔR15T1–T0: The R15 difference between T1 and T0; ΔR15T2–T0: The R15 difference between T2 and T0; ΔR15T2–T1: The R15 difference between T2 and T1; CI: Confidential interval; AUC: Area under the curve.

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