Immunomodulation by Hemoadsorption-Changes in Hepatic Biotransformation Capacity in Sepsis and Septic Shock: A Prospective Study

Background: Sepsis is often associated with liver dysfunction, which is an indicator of poor outcomes. Specific diagnostic tools that detect hepatic dysfunction in its early stages are scarce. So far, the immune modulatory effects of hemoadsorption with CytoSorb (R) on liver function are unclear. Method: We assessed the hepatic function by using the dynamic LiMAx (R) test and biochemical parameters in 21 patients with sepsis or septic shock receiving CytoSorb (R) in a prospective, observational study. Points of measurement: T-1: diagnosis of sepsis or septic shock; T-2 and T-3: 24 h and 48 h after the start of CytoSorb (R) ; T-4: 24 h after termination of CytoSorb (R) . Results: The hepatic biotransformation capacity measured by LiMAx (R) was severely impaired in up to 95 % of patients. Despite a rapid shock reversal under CytoSorb (R) , a significant improvement in LiMAx (R) values appeared from T-3 to T-4. This decline and recovery of liver function were not reflected by common parameters of hepatic metabolism that remained mostly within the normal range. Conclusions: Hepatic dysfunction can effectively and safely be diagnosed with LiMAx (R) in ventilated ICU patients under CytoSorb (R). Various static liver parameters are of limited use since they do not adequately reflect hepatic dysfunction and impaired hepatic metabolism.