Real-time assessment of hepatic function is related to clinical outcome in critically ill patients after polytrauma.
OBJECTIVE
The aim was to investigate the outcome MODS/MOF in critically ill patients with regard to early hepatic dysfunction.


METHODS
Thirty adult polytrauma patients admitted to the ICU, with ISS >or=16 were prospectively investigated. Real-time liver function was assessed using the MEGX test and arterial ketone body ratio (AKBR) 12-24 h after admittance to ICU, and on days 3, 5, 8, 12.


RESULTS
Six patients (19%) died between days 4 and 29. Non-survivors were older (64.2 vs. 31.5 years), had a significantly higher ISS (40.5 vs. 30; p=0.002) and MODS score (9.5 vs. 5; p=0.001) on admittance to the ICU than survivors. On day 3 MEGX values (31 vs. 71.3 microg/L; p=0.001) and the AKBRs (0.6 vs. 1.3; p=0.001) were significantly lower in non-survivors than in survivors whereas IL-6 levels were significantly higher in the former group (519 vs. 61 microg/L; p=0.05).


CONCLUSIONS
The MEGX test and AKBR are sensitive early indicators of hepatic dysfunction in severely injured polytrauma patients at risk for developing MODS/MOF.
Dresing
Klaus
K
Department of Trauma Surgery, Plastic and Reconstructive Surgery, University Medicine Goettingen, Georg-August University, Robert-Koch-Strasse 40, D 37075 Göttingen, Germany. klaus.dresing@med.uni-goettingen.de
Armstrong
Victor William
VW
Leip
Casper-Lennart
CL
Streit
Frank
F
Burchardi
Hilmar
H
Stürmer
Klaus-Michael
KM
Oellerich
Michael
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness; D016207:Cytokines / Q000097:blood / Q000378:metabolism; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007657:Ketone Bodies / Q000097:blood / Q000378:metabolism; D008099:Liver / Q000503:physiopathology*; D008111:Liver Function Tests / Q000379:methods; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D009102:Multiple Organ Failure / Q000097:blood / Q000378:metabolism / Q000503:physiopathology*; D015203:Reproducibility of Results; D013997:Time Factors
D016207:Cytokines; D007657:Ketone Bodies