Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Dec;5(1):47.
doi: 10.1186/s13613-015-0092-6. Epub 2015 Dec 4.

Prognostic impact of ICG-PDR in patients with hypoxic hepatitis

Thomas Horvatits  1   2 , Nikolaus Kneidinger  3 , Andreas Drolz  4   5 , Kevin Roedl  6   7 , Karoline Rutter  8   9 , Stefan Kluge  10 , Michael Trauner  11 , Valentin Fuhrmann  12   13
Affiliations

Prognostic impact of ICG-PDR in patients with hypoxic hepatitis

Thomas Horvatits et al. Ann Intensive Care. 2015 Dec.

Abstract

Background: Hepatic impairment is found in up to 20 % in critically ill patients. Hypoxic/ischemic hepatitis (HH) is a diffuse hepatic damage associated with high morbidity and mortality. Indocyanine green plasma disappearance rate (ICG-PDR) is an effective tool assessing liver function in acute and chronic hepatic diseases. Aim of this study was to evaluate the prognostic impact of ICG-PDR in comparison to established parameters for risk stratification.

Methods: Patients with HH were included in this prospective observational study and compared to cirrhosis, acute liver failure (ALF) and patients without underlying liver disease. ICG-PDR, measured non-invasively by finger pulse densitometry, was assessed on admission and in patients with HH serially and results were compared between groups. Diagnostic test accuracy of ICG-PDR predicting 28-day mortality was analyzed by receiver operating characteristics (ROC).

Results: ICG-PDR on admission was significantly lower in patients with liver diseases than in patients without hepatic impairment (median 5.7 %/min, IQR 3.8-7.9 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 < 0.001). In patients with HH, ICG-PDR was identified as best predictor of 28-day mortality which performed significantly better than SOFA, lactate, INR and AST over course of time (p < 0.05). Best cut-off for identification of 28-day survivors was ICG-PDR ≥9.0 %/min 48 h after admission.

Conclusions: ICG-PDR is an independent predictor of mortality in patients with liver disease. Diagnostic test accuracy of ICG-PDR was superior to standard liver function parameters and established scoring systems in patients with HH.

Keywords: Hypoxic hepatitis; ICG-PDR; Indocyanine green plasma disappearance rate; Ischemic hepatitis.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
ICG-PDR on admission in different liver disease entities. HH, liver cirrhosis, ALF vs. patients without hepatic impairment (median 5.7 %/min, IQR 3.8–7.9 vs. 20.7 %/min, IQR 14.1–25.4 %/min; p < 0.001). Box plot marks median, interquartile ranges and extreme values. HH hypoxic hepatitis, ALF acute liver failure
Fig. 2
Fig. 2
ROC predicting 28-day mortality in patients with HH a on admission and b 48 h after admission. AST aspartate aminotransferase level, INR international normalized ratio
Fig. 3
Fig. 3
Time course of ICG-PDR in patients with HH. ICG-PDR measurement on 4 consecutive days after admission in 30 patients with HH that survived until day 5. Repeated measures ANOVA showed a significant effect of time of ICG-PDR in 28-day survivors (p < 0.001)
See this image and copyright information in PMC

References

    1. Kramer L, Jordan B, Druml W, Bauer P, Metnitz PG. Incidence and prognosis of early hepatic dysfunction in critically ill patients—a prospective multicenter study. Crit Care Med. 2007;35(4):1099–1104. doi: 10.1097/01.CCM.0000259462.97164.A0. - DOI - PubMed
    1. Horvatits T, Trauner M, Fuhrmann V. Hypoxic liver injury and cholestasis in critically ill patients. Curr Opin Crit Care. 2013;19(2):128–132. doi: 10.1097/MCC.0b013e32835ec9e6. - DOI - PubMed
    1. Jager B, Drolz A, Michl B, Schellongowski P, Bojic A, Nikfardjam M, et al. Jaundice increases the rate of complications and 1-year mortality in patients with hypoxic hepatitis. Hepatology. 2012;56(6):2297–2304. doi: 10.1002/hep.25896. - DOI - PubMed
    1. Henrion J, Schapira M, Luwaert R, Colin L, Delannoy A, Heller FR. Hypoxic hepatitis: clinical and hemodynamic study in 142 consecutive cases. Medicine (Baltimore). 2003;82(6):392–406. doi: 10.1097/01.md.0000101573.54295.bd. - DOI - PubMed
    1. Fuhrmann V, Kneidinger N, Herkner H, Heinz G, Nikfardjam M, Bojic A, et al. Impact of hypoxic hepatitis on mortality in the intensive care unit. Intensive Care Med. 2011;37(8):1302–1310. doi: 10.1007/s00134-011-2248-7. - DOI - PubMed

LinkOut - more resources