Füsun EROĞLU, Şenol GÜLMEN, Ömer Rıdvan TARHAN, Lütfi YAVUZ, Berit Gökçe CEYLAN, Adnan ALACA

The effects of adjuvant therapies for sepsis on hepatic and renal function: a retrospective analysis of 108 ICU patients

As liver and kidney failure have a direct effect on mortality, morbidity, and intensive care unit (ICU) length of stay in sepsis patients, maintaining their functions or minimizing the degree of failure should be one of the most important goals of therapy. In this retrospective study we investigated the effects of recently introduced adjuvant therapies on hepatorenal functions in septic ICU patients. Materials and methods: We conducted comparative and retrospective data analysis of 108 patients with sepsis that were followed-up during a 2-year period in the ICU. We recorded AST, ALT, ALP, albumin, bilirubin, and INR in order to evaluate variations in hepatic functions, and we recorded creatinine, BUN, and mean hourly urinary output in order to evaluate variations in renal functions in patients that received standard antibiotherapy only (ST group), in those that received polyvalent IgM-enriched immunoglobulin therapy added to standard antibiotherapy (IVIg group), and in those that received recombinant human-activated protein C therapy added to standard antibiotherapy (APC group). Variables at the beginning of the treatments and 96 h post-treatment were assessed. Results: In total, 108 patients were analyzed (IVIg group: n = 20 in; APC: group n = 22; ST group: n = 66). The groups were homogeneous in terms of initial hepatic and renal functions, according to AST, ALT, albumin, INR, bilirubin, BUN, creatinine, and mean hourly urinary output. In the APC group the AST level at 96 h was significantly lower than that at baseline (0 h), and in the ST group 96-h bilirubin was lower than that at baseline (0 h) (P = 0.035 and P = 0.015, respectively). Conclusion: We retrospectively observed that the adjuvant therapies did not improve hepatorenal functions in our ICU septic patients.

Anahtar Kelimeler:

Key words: Sepsis, hepatic functions, renal functions, activated protein C, intravenous immunoglobulin

The effects of adjuvant therapies for sepsis on hepatic and renal function: a retrospective analysis of 108 ICU patients

Keywords:

Key words: Sepsis, hepatic functions, renal functions, activated protein C, intravenous immunoglobulin,

PDF

___

Yıldız BD, Yorgancı K. Current trends and future implications in sepsis treatment. Turk J Med Sci 2008; 38: 501-10.
Rice TW. Treatment of severe sepsis: where next? Current and future treatment approaches after the introduction of drotrecogin alpha. Vasc Health Risk Manag 2006; 2: 3-18.
Lehmann C, Meissner K, Knöck A, Diedrich S, Pavlovic D, Gründling M et al. Activated protein C improves intestinal microcirculation in experimental endotoxaemia in the rat. Crit Care 2006; 10: R157.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985; 13: 818-29.
Neilson AR, Burchardi H, Schneider H. Cost-effectiveness of immunoglobulin M-enriched immunoglobulin (Pentaglobin) in the treatment of severe sepsis and septic shock. J Crit Care 2005; 20: 239-49.
Crouser ED. Mitochondrial dysfunction in septic shock and multiple organ dysfunction syndrome. Mitochondrion 2004; 4: 729-41.
Satoi S, Kamiyama Y, Kitade H, Kwon AH, Takahashi K, Wei T et al. Nitric oxide production and hepatic dysfunction in patients with postoperative sepsis. Clin Exp Pharmacol Physiol 2000; 27: 197-201.
Strassburg CP. Shock liver. Best Pract Res Clin Gastroenterol 2003; 17: 369-81
Ramakers BP, de Goeij M, van der Hoeven JG, Peters WH, Pickkers P. Inflammation-induced hepatotoxicity in humans. Shock 2009; 31: 151-6.
Langenberg C, Bellomo R, May C, Wan L, Egi M, Morgera S. Renal blood flow in sepsis. Crit Care 2005; 9: R363-74.
Bellomo R, Wan L, Langenberg C, May C. Septic acute kidney injury: new concepts. Nephron Exp Nephrol 2008; 109: 95-100.
Gupta A, Gerlitz B, Richardson MA, Bull C, Berg DT, Syed S et al. Distinct Functions of Activated Protein C Differentially Attenuate Acute Kidney Injury. J Am Soc Nephrol 2009; 20: 267-77.
Gupta A, Berg DT, Gerlitz B, Sharma GR, Syed S, Richardson MA et al. Role of protein C in renal dysfunction after polymicrobial sepsis. J Am Soc Nephrol 2007; 18: 860-7.
Mikaszewska-Sokolewicz M, Nierebińska M, Mayzner- Zawadzka E. Use of drotrecogin alfa (activated) in two patients with severe sepsis. Med Sci Monit 2003; 9: CS80-7.
Hoffman JN, Fertmann JM, Vollmar B, Laschke MW, Jauch KW, Menger MD. Immunoglobulin M-enriched human intravenous immunoglobulins reduce leukocyte-endothelial cell interactions and attenuate microvascular perfusion failure in normotensive endotoxemia. Shock 2008; 29: 133-9.