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Prognostic impact of ICG-PDR in patients with hypoxic hepatitis at the intensive care unit
© Horvatits et al.; 2015
Published: 1 October 2015
Hypoxic hepatitis (HH) is a frequent cause of acute hepatocellular damage in critically ill patients associated with high mortality. Indocyanine green, a medical dye, is removed solely by the liver without entering enterohepatic circulation. Therefore its plasma disappearance rate (ICG-PDR) is an effective clinical tool for assessment of liver function in acute and chronic hepatic disease.
Aim of this study was to evaluate the prognostic impact of ICG-PDR in comparison to laboratory parameters and established scores in critically ill patients with HH and other liver disease entities.
The impact of ICG-PDR was prospectively evaluated in 119 critically ill patients with different liver disease entities (HH: n = 52, cirrhosis: n = 35, acute liver failure (ALF): n = 10, control group without signs of acute liver injury, viral or drug induced hepatitis or cirrhosis: n = 22). Plasma disappearance rate of ICG was measured non-invasively by using a finger pulse densitometry system.
ICG-PDR on admission was significantly lower in patients with liver diseases (HH, liver cirrhosis, ALF) than in the control group without hepatic impairment (median 5.7%/min, IQR 3.8-7.9%/min vs. 20.7%/min, IQR 14.1-25.4%/min; p < 0.001).
ICG-PDR predicted 28-day mortality independently of SOFA score and serum lactate in patients with underlying liver disease (HR 1.27, 95%CI 1.10-1.45; p < 0.005). AUROC of ICG-PDR predicting 28-day mortality in patients with HH was significantly higher than AUROC of SOFA, arterial serum lactate, INR and AST 48 hours after admission (p < 0.05). ICG-PDR increased significantly in 28-day survivors over course of time (p < 0.001). 28-day survivors could be identified using a cut-off ICG-PDR ≥ 9.0 %/min 48 hours after admission with sensitivity of 77% and specificity 100%.
Diagnostic test accuracy of ICG-PDR was superior to standard liver function parameters and well established scoring systems in patients with HH. Therefore ICG-PDR is a feasible non-invasive tool for early risk stratification in patients with HH.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.