Sepsis Outcomes Associated with Liver Disease

SUMMARY:

  • Although rare, liver failure in sepsis has a profound impact on mortality.

  • Liver disease with sepsis requires more critical care support vs without liver disease.

  • Clinicians should consider liver disease as a variable in sepsis patients moving in the future.

REVIEW:

  • Non-alcoholic fatty liver disease, recently renamed steatotic liver disease, may have a significant impact on the course of sepsis due to its association with:

    • Low-grade inflammation
    • Microvascular endothelial dysfunction
    • Insulin resistance;
    • Impaired immune response.
    • There is limited data on the impact of liver disease on the course of sepsis and its outcomes.

  • There are a number of various liver disease severity scores. These include:

    • AST to Platelet Ratio (APRI)
    • Fibrosis-4 Index for Liver Fibrosis (FIB-4)
    • Non-Alcoholic Fatty Liver Disease Score (NAFLD)
    • FibroScan AST score (FAST)
    • Controlled Attenuation Parameter (CAP)
      • Commonly used to assess steatosis severity
      • Various CAP cut points have been used to grade different levels of liver steatosis.

SEPSIS AND LIVER DISEASE:

  • Recent evaluation (Krznaric J, et al Journal of Clinical Medicine;2024:13;798) on the evaluation of hospital mortality rates in 378 patients with sepsis with or without liver disease.

  • No difference between groups in terms of:

    • Hospital length of stay
    • Need for ICU admission
    • Need for vasopressor
  • Liver failure patients significantly were:
    • Required mechanical ventilation
    • Developed acute kidney injury
    • Required renal replacement therapy
  • Mortality was greater in the liver disease patients with a greater 28 day.
    • Higher mortality was associated with:
      • CAP > 270 dB/m
      • NAFLD > 1.3
      • FIB-4 score > 3.0
      • FAST score > 0.35

CONCLUSIONS:

  • Sepsis associated liver disease has a high morbidity and mortality associated with it.

  • The role of liver disease in severe infections remain unclear, however, liver disease is associated with physiologic changes which could impact the course of sepsis.

  • Liver disease should be a patient variable to consider in future sepsis patients.

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Erkan Hassan is the Co-Founder & Chief Clinical Officer of Sepsis Program Optimization where he designs & oversees the implementation of solutions to optimize sepsis programs.

To discuss your organization’s Barriers of Effective Sepsis Care, contact Erkan by phone (844) 4SEPSIS (844-473-7747), email (erkan@spo.icu), or video chat.