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ORIGINAL ARTICLE
Year : 2013  |  Volume : 25  |  Issue : 1  |  Page : 15-19

Hepatic blood flow in late sepsis patients


1 Department of Internal Medicine, Vascular Laboratory of the Medical Emergency Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
2 Ayatt Central Hospital, Ministry of Health, 12111 Giza, Egypt

Correspondence Address:
Abir Zakaria
MD, Department of Internal Medicine, Vascular Laboratory of the Medical Emergency Unit, Faculty of Medicine, Cairo University, Cairo
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.7123/01.EJIM.0000425955.92493.b0

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Background

Systemic inflammatory response syndrome (SIRS), sepsis, and severe sepsis influence total hepatic blood flow. However there are conflicting data on the time of its assessment, methodology, study design, and differentiation in terms of whether the condition is an experimental SIRS, sepsis, or a human clinical syndrome.

Objective of the study

The aim of this study was to assess the total hepatic blood flow and the contribution of hepatic arterial blood flow (HABF) and portal venous blood flow using a Doppler vascular ultrasound in SIRS, sepsis, and severe sepsis patients, aiming at a clear prognostic parameter that can predict the patient’s outcome.

Results

There was a clear cutoff point of 16.09 ml/min for HABF, above which the hazard ratio for death was 5.6046, with a 95% confidence interval of 2.0078–15.6451 and a P-value of 0.0011 in late sepsis patients. The predictive potential for this HABF cutoff for patient mortality showed a sensitivity of 80%, specificity of 73.7%, positive predictive value of 70.6%, negative predictive value of 82.4%, 95% confidence interval of 0.612–0.907, and P-value of less than 0.0004. There was a significant positive correlation between the HABF and APACHE II scores (P=0.023). Cox regression analysis showed that only the APACHE II score and HABF were independent predictors for patients’ outcome.

Conclusion

Duplex ultrasound assessment was a useful bedside method for predicting mortality in late sepsis patients through estimation of HABF, with a reasonable predictive potential at a definite cutoff level.



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