Prognostische Bedeutung und ätiologische Aspekte von Leberfunktionsstörungen bei internistischen Intensivpatienten

摘要

The present retrospective study deals with the importance of liver dysfunction regarding internal critical care patients. The following aims were persuited by the study: 1. Evaluation of the prognostic importance of the hepatic function. 2. To attain an overview of hepatic function development and the incidence of liver dysfunktion of internal critical care patients. 3. Identification of atiologic aspects of liver dysfunction. 4. Effects of hepatic dysfunction on other organ systems. 300 patient records of an internal intensive care unit were analysed regarding the liver function at admission and its changes under critical care treatment. The patients were organized into four groups: Group I: Patients having no raised liver enzymes during the whole treatment Group II: Patients having a steady recovery of a liver dysfunction Group III: Patients having a constant persisting liver dysfunction Group IV: Patients with worsening of the liver function. The analysis of the liverspecific marker revealed, that 60% of critical care patients did not have a liver dysfunction during the whole treatment at all. 23% of all patients had a dysfunction of the liver at admission to the critical care unit, a recovery of this constricted liver funkction was seen in 62% of these patients. A constant worsening of the liver function was surveyed in 21% of all patients. To evaluate the prognostic importance of the liver function we surveyed the mortality rate and lengths of stay on the critical care unit. The patients with worsening of liver function had a significant higher risk to die and tended to stay longer on the ward, especially compared to the patients without a liver dysfunction (41% vs.15%; X=19,9 days vs. X= 10,8 days). The higher mortality-rate and longer stay on the critical care unit revealed, that patients with a constant worsening of the liver function had a worse prognosis than the other patients. Both of these observations can be a result of a higher morbidity. The condition of the hepatic organ system at admission to a critical care unit does not allow any conclusion about its development during critical care treatment. Worsening of the liver function was seen in approximately the same percentage of patients, independently whether there was a liver dysfunction or not at admission to the critical care unit (17% vs. 22%). Especially males tended to have a worsening of liver function (67% of group IV were males), and females tended to have a greater recovery potency (80% of group II were female). The age did not have a significant impact on the liver function. The hepatic organ system can be influenced by different kinds of treatment. This study revealed a singificant association between transfusionrate and worsening of the liver function (Group I: X=1,7 transfusions vs. Group IV: X=6 transfusions). The application of total parenteral nutrition over a longer period of time also seemed to be associated with an impairment of the liver function. Regarding drugs, almost half of the applied substances had a potencially hepatotoxicity (47,5%; n=133). Patients of goup IV were applied the highest number of these drugs (X=7,4). Especially compared to the patients without liver dysfunction (X=4,8 potentially hepatotoxic drugs) there was a significant difference. On the one hand these kind of above mentioned treatments themselves could trigger liver dysfunction. On the other hand patients who get all these different kind of treatment (parenteral nutrition, transfusions, high number of different drugs) are the more ciritical ill persons. The dysfunction of the liver could once again be an indicator for a higher morbidity. Interaction between the renal and hepatic organ system ist already known under physiological circumstances and becomes obvious under pathologic conditions. In this study both organ function were opposed to each other. But because of the missing data it was not possible to evaluate the renal function correctly and therefore no significant relation between the renal and hepatic organ system could be drawn. An increase of liver enzymes is often been seen in critical ill patients. Still more emphasis is placed on the cardiac, pulmonary and renal organ systems. But this study pointed out that changes in liver function also have prognostic significance and should not be underestimated.