Hepatic dysfunction: A common occurrence in severely injured patients.
BACKGROUND
Hepatic dysfunction (HD) is a common finding in critically ill patients. The underlying pathophysiological process is one of either cholestasis or hypoxic liver injury (HLI). Using serum bilirubin, our study aimed to determine the incidence of HD in a critically ill trauma population, identify risk factors and analyse the impact on outcomes.


METHODS
A retrospective observational study was performed on all patients admitted to the Level 1 Trauma Unit ICU at Inkosi Albert Luthuli Central Hospital in Durban, South Africa (IALCH) from 01/01/2012 until 31/12/2012. HD was defined as a total bilirubin greater than 34.2μmol/l (2mg/dL). Additional demographic, physiological, biochemical, and pharmaceutical risk factors for hepatic dysfunction were identified and recorded.


RESULTS
Two hundred and twenty five patients were included in the study of whom 48 (21.3%) developed HD. An increased duration of ventilation (median 15days [inter-quartile range 6-19] vs 6days [IQR 3-11] p<0.001), prolonged length of stay (median 19days [IQR 8.5-31] vs 7days [IQR 3-13] p<0.001), and higher mortality rate (31.3% vs. 14.7% p=0.01) were all significantly associated with HD. Shock on admission was twice as common in patients developing HD (p<0.001). The only drugs associated with HD were piperacillin-tazobactam (p<0.001) and enalapril (p=0.04). On multivariable analysis however, HD was not associated with mortality.


CONCLUSIONS
HD was common in our study population, and was associated with other organ dysfunction, increased mortality and length of stay.
Department of Surgery, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa.
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A
Saloojee
Department of Anaesthetics and Critical Care, Perioperative Research Group, University of KwaZulu-Natal, South Africa. Electronic address: drdavidskinner@gmail.com.
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DL
Skinner
Department of Surgery, Inkosi Albert Luthuli Central Hospital and University of KwaZulu-Natal, South Africa.
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E
Loots
University of KwaZulu-Natal Trauma Surgery Training Unit, Deputy Director: IALCH Trauma Service and Trauma ICU, KwaZulu-Natal Department of Health, South Africa.
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TC
Hardcastle
Department of Surgery, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa.
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DJ
Muckart
D000293:Adolescent; D000328:Adult; D001663:Bilirubin / Q000097:blood; D056486:Chemical and Drug Induced Liver Injury / Q000150:complications* / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D002780:Cholestasis, Intrahepatic / Q000150:complications* / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D000860:Hypoxia / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D007902:Length of Stay; D008099:Liver / Q000293:injuries / Q000473:pathology / Q000503:physiopathology*; D008297:Male; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D055815:Young Adult
D001663:Bilirubin
Hepatic dysfunction; Trauma critical care