Source: Annual Congress 2002 - Clinical aspects of antibiotic and nonantibiotic therapy of pneumonia in the ICU
Disease area: Respiratory infections

Abstract

The early diagnosis of hepatic dysfunction in patients with severe CAP could help to avoid extended organs damage and improve the survival. The MEGX test, a dynamic liver function test, is more sensitive and specific parameter than conventional liver function tests. The aim of this investigation was to determine if hepatic dysfunction is related to the systemic inflammatory response in patients with CAP meeting sepsis criteria. The MEGX test was carried out on days 1- 10 after admittance to the intensive care unit. Blood samples for determination of serum concentrations of hyaluronic acid, CRP, IL-6, IL-8, IL-10 and conventional liver function tests (AST, ALT, bilirubin, albumin) were also drawn. Patients (n=30) were classified into two groups according to SAPS II severity score. Patients in group I (n=15) had a SAPS II probability of mortality >3% while those in group II (n=15) had a SAPS II < 3%. The median MEGX level determined on days 1-10 after admittance to ICU in patients with the severe cases (median 24 μg/l; range 3-99 μg/l) was significantly lower than that in group II (median 65 μg/l; range 23-145 μg/l; p< 0.001). IL-6, IL-8, IL-10 and CRP concentrations were markedly elevated in group I compared to group II on days 1-10 (p<0.0001). There was a highly significant inverse correlation between MEGX and the SAPS II score (r=-0.56; p=0.0001), IL-6 (r=-0. 61; p=0.0001), and hyaluronic acid (r=-0.43; p=0.0001). Conventional static liver function tests did not differ between the groups. We determined that MEGX test is a sensitive marker of liver function in patients with CAP. Diminished MEGX production is associated with enhanced inflammatory response during severe CAP.

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A. A. Igonin, V. W. Armstrong, M. Shipkova, V. G. Kukes, M. Oellreich (Moscow, Russia; Goettingen, Germany). Detection of liver function in patients with severe community-acquired pneumonia (CAP). Eur Respir J 2002; 20: Suppl. 38, 227

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