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Indocyaningrün-Elimination als Maß der Leberfunktion

Prognostische Bedeutung bei Patienten mit ambulant erworbener Sepsis

Indocyanine green elimination for the evaluation of liver function

Prognostic value in patients with community-acquired sepsis

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Zusammenfassung

Hintergrund

Im Rahmen der vorliegenden Studie sollte untersucht werden, ob bei Patienten in der Frühphase einer ambulant erworbenen Sepsis („community-acquired sepsis“, CAS) ein Zusammenhang zwischen der Leberfunktion, gemessen über die Indocyaningrün(ICG)-Elimination, und dem klinischen Verlauf existiert.

Material und Methoden

Es wurden 341 CAS-Patienten (≥ 18 Jahre, n = 341) mit Verdacht/Nachweis einer Infektion sowie dem Vorliegen von ≥ 2 Kriterien des „systemic inflammatory response syndrome“ (SIRS) in die Beobachtungsstudie „Prognose der frühen Sepsis 2“ (ProFS 2) eingeschlossen. Ausgeschlossen wurden Patienten, deren letzte Hospitalisation weniger als 7 Tage zurücklag.

Bei der hier betrachteten Subgruppe von Patienten, die auf eine Wach-/Intensivstation verlegt wurden, erfolgte zum Aufnahmezeitpunkt (n = 72) und nach 96 h (n = 34) die nichtinvasive Messung der ICG-Elimination (LiMON, Fa. PULSION Medical Systems, Deutschland). Erhoben wurden die ICG-Plasmaverschwinderate (ICG-PDR, %/min) und die ICG-Retentionsrate nach 15 min (ICG-R15, %), die mit klinischen Endpunkten und konventionellen Laborparametern zur Beschreibung der Leberfunktion korreliert wurden. Als primärer Endpunkt wurde die 30-Tage-Sterblichkeit, als sekundäre Endpunkte wurden die Notwendigkeit eines Nierenersatzverfahrens, eine invasive Beatmungspflicht und die Aufenthaltsdauer auf einer Wach-/Intensivstation definiert.

Ergebnisse und Schlussfolgerung

Patienten mit septischem Schock zeigen eine signifikant verminderte ICG-Elimination im Vergleich zu Patienten mit einer (schweren) Sepsis. Bei den Patienten mit entwickelten dialysepflichtigem Nierenversagen (n = 12) fand sich ferner bereits zum Aufnahmezeitpunkt eine signifikante Einschränkung der ICG-Elimination. Zudem war eine reduzierte ICG-Elimination mit längeren Aufenthaltstagen auf einer Wach-/Intensivstation assoziiert. Ein Zusammenhang zwischen der ICG-Elimination am Aufnahmetag und der 30-Tage-Sterblichkeit (n = 14) oder der Notwendigkeit einer invasiven Beatmung (n = 20) wurde nicht festgestellt.

Abstract

Background

The aim of our clinical study was to correlate liver function measured by indocyanine green (ICG) elimination and clinical outcomes in patients with an early stage of community-acquired sepsis (CAS).

Materials and methods

A total of 341 patients (≥ 18 years) presenting with suspicion of CAS or evidence of an infection and fulfillment of ≥ 2 systemic inflammatory response syndrome (SIRS) criteria were included in the observational study“Prognosis of early sepsis 2” (Prognose der frühen Sepsis 2, ProFS 2). Patients who had been hospitalized within the last 7 days were excluded.

In a subgroup of these patients (n = 72) who were transferred to an intensive or intermediate care unit according to the clinical judgment of the treating physicians, ICG elimination (plasma disappearance rate, ICG-PDR; 15 min retention rate, ICG-R15) was assessed by using a noninvasive monitoring system (LiMON, PULSION Medical Systems, Germany). ICG-PDR and -R15 were determined on the day of admission (n = 72) and after 96 h (n = 34). The primary end point of the study was defined as death within 30 days. Secondary endpoints were need for renal replacement therapy, requirement for invasive mechanical ventilation, and length of stay in an intermediate or intensive care unit.

Results and conclusion

In contrast to patients with sepsis or severe sepsis, ICG elimination was found to be significantly impaired in patients with septic shock. Furthermore, a significant predictive value of ICG-PDR and -R15 on the day of admission for the need for subsequent renal replacement therapy (n = 12) was observed. In addition, reduced ICG elimination was associated with a longer stay in an intermediate or intensive care unit. However, ICG elimination on admission could not predict 30-day mortality (n = 14) or requirement of mechanical ventilation (n = 20).

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Einhaltung ethischer Richtlinien

Interessenkonflikt. S. A. Kaulen, C. Hübner, J. Mieth, K. Spindler, R. Schwab, R. Wimmer, J. Wilhelm, M. Amoury, M. Girndt, K. Werdan und H. Ebelt geben an, dass kein Interessenkonflikt besteht.

Alle im vorliegenden Manuskript beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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Authors and Affiliations

  1. Universitätsklinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06097, Halle (Saale), Deutschland

    S.A. Kaulen, C. Hübner, J. Mieth, K. Spindler, R. Schwab, R. Wimmer, J. Wilhelm, K. Werdan & H. Ebelt

  2. Zentrale Notaufnahme, Universitätsklinikum Halle, Halle (Saale), Deutschland

    M. Amoury

  3. Universitätsklinik und Poliklinik für Innere Medizin II, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland

    M. Girndt

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  1. S.A. Kaulen
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  2. C. Hübner
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  3. J. Mieth
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Correspondence to S.A. Kaulen.

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Kaulen, S., Hübner, C., Mieth, J. et al. Indocyaningrün-Elimination als Maß der Leberfunktion . Med Klin Intensivmed Notfmed 109, 531–540 (2014). https://doi.org/10.1007/s00063-014-0374-z

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