Septic shock in patients with cirrhosis: Hemodynamic and metabolic characteristics and intensive care unit outcome

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Objectives:To examine the hemodynamic and metabolic characteristics and ICU outcome of septic shock in patients with cirrhosis.Design:Prospective, comparative study. Measurements performed in the first 24 hrs of septic shock.Setting:A general hospital ICU.Patients:Twelve patients with cirrhosis and 23 patients without cirrhosis admitted for septic shock.Measurements and Main Results:Arterial pressure was measured using an arterial catheter. Pulmonary arterial and right atrial pressures were measured by using a pulmonary artery catheter. Cardiac output was determined by using the thermodilution method. Pulmonary arterial L-lactate plasma concentrations were measured using an automated spectrophotometer, and blood temperature was measured using a cardiac output computer. Arterial and mixed venous Po2, Pco2, and pH values were measured by using specific electrodes. Oxygen saturations and hemoglobin concentrations were measured using a hemoximeter. Patients with cirrhosis had decompensated liver disease (grade C of the Child-Pugh classification). The number of Gram-negative infections and therapeutic interventions were similar in both groups. Patients with cirrhosis had higher cardiac indices (5.14 ± 0.52 [se] VS. 3.91 ± 0.30 L/min/m2, p < .05), plasma lactate concentrations (9.0 ± 2.0 vs. 5.2 ±0.7 mmol/ L, p < .05) and ICU mortality rates (100% vs. 43%, p < .05), and lower blood temperatures (35.5 ± 0.6 vs. 37.6 ± 0.2°C, p < .05) than patients without cirrhosis. Systemic vascular resistance, arterial pressure, pulmonary arterial pressure, oxygen delivery and consumption, and arterial and mixed venous acid-base status were not significantly different between the two groups.Conclusions:In patients with cirrhosis, septic shock was characterized by severe liver dysfunction, low blood temperature, marked increases in cardiac index and lactic acidemia, and a 100% ICU mortality rate. These findings should be taken into account if patients with cirrhosis are to be included in controlled studies on septic shock.

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