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| Clinical value of bedside ultrasound in detecting hepatic hemodynamics in patients with sepsis shock complicated with liver injury |
| Sang Zhen-zhen, Gao Jie, Jia Chun-mei, Li Yong |
| Department of Emergency, Cangzhou Central Hospital, Cangzhou 061000, China |
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Abstract Objective To investigate the clinical value of bedside color Doppler ultrasound in detecting the hemodynamic changes of hepatic artery and portal vein in patients with sepsis shock complicated with liver injury. Methods A total of 254 septic shock patients admitted to EICU of Cangzhou Central Hospital from December 2016 to February 2019 were selected as the research subjects. According to the occurrence of acute liver injury, they were divided into the liver injury group (86 cases) and the non-liver injury group (168 cases). Patients in the liver injury group were further divided into mild liver injury group (20 cases), moderate liver injury group (25 cases) and severe liver injury group (41 cases) according to the degree of liver injury. The cases were divided into survival group (26 cases) and non-survival group (60 cases) according to 28-day mortality. Forty healthy individuals were selected as control. We collected clinical data of the subjects. The peak velocity of hepatic artery (HAPSV), average flow rate (HAVmean), resistance index (HARI), maximum blood flow velocity (PVVmax), portal vein average blood flow velocity (PVVmean) and portal vein filling index (PVCI) were determined by bedside color Doppler ultrasonography. Binary Logistic regression was used to analyze the prognostic risk factors of septic shock patients combined with liver injury. Results ①Compared with the control group ［HAPSV: (47.53±15.24)cm/s, HAVmean: (25.41±8.64)cm/s, PVVmax: (18.96±2.15)cm/s, PVVmean: (12.06±2.47)cm/s, PVCI: (0.052±0.019)cm·s, HARI: (0.657±0.042) cm/s］, the HAPSV, HAVmean, PVVmax, PVVmean and PVCI of septic shock patients decreased significantly ［HAPSV: (45.78±16.59) cm/s, HAVmean: (23.56±9.32)cm/s, PVVmax: (17.62±2.36)cm/s, PVVmean: (11.79±2.82)cm/s, PVCI: (0.048±0.012)cm·s］, while HARI (0.708±0.035)increased, with statistically significant differences(P＜0.01). There was no significant difference in the above parameters between the septic shock group without liver injury and the mild liver injury group (P＞0.05). ②With the increase of the severity of liver injury, HARI showed an increasing trend, and the HARI (0.754±0.046) of severe hepatic injury group was significantly higher than that in mild (0.714±0.037) and moderate liver injury group (0.726±0.024), with statistically significant differences (P＜0.01). While HAPSV, HAVmean, PVVmax, PVVmean and PVCI presented a downward trend, and these indicators in the severe liver injury group ［HAPSV: (40.68±15.69)cm/s, HAVmean: (21.56±10.87)cm/s, PVVmax: (13.68±3.09)cm/s, PVVmean: (9.56±2.32)cm/s, PVCI: (0.040±0.016)cm·s］were significantly lower than those in the mild ［HAPSV: (45.31±17.26)cm/s, HAVmean: (24.73±10.85)cm/s, PVVmax: (17.31±2.95)cm/s, PVVmean: (11.73±3.06)cm/s, PVCI: (0.048±0.007)cm·s］and moderate liver injury group ［HAPSV: (43.16±13.40)cm/s, HAVmean: (22.54±9.58)cm/s, PVVmax: (15.76±3.14)cm/s, PVVmean: (10.64±2.51)cm/s, PVCI: (0.042±0.014)cm·s］, with statistically significant differences (P＜0.01). ③Binary Logistic regression analysis found that the severity of liver injury, APACHEⅡ score, SOFA score, PCT and HARI were independent risk factors affecting the prognosis of patients with septic shock combined with liver injury, and the risk ratio (OR) values were 5.396, 4.565, 4.173 and 2.753. Conclusion The measurement of hepatic hemodynamics by bedside color Doppler ultrasound can effectively reflect the degree of liver injury in patients with septic shock combined with liver injury, which has certain clinical value for prognosis evaluation.
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Corresponding Authors:
Li Yong, E-mail: sangzhenzhen1985@163.com
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