Abstract
INTRODUCTION: Circulatory shock is not an uncommon clinical condition in critically ill patients. This can affect various organs including liver. Usually, acute liver injury is identified as a change in biochemical values. Recent advancements in ultrasonography, like transient elastography, commonly known as fibroscan, has been used to detect liver dysfunction in critically ill patients [1]. However, application of 2D shear wave elastography (2D SWE) has not been studied in patients with circulatory shock. Objective: We aimed to study prevalence of increased liver stiffness in ICU patients having circulatory shock. MATERIALS AND METHODS: After Institutional Ethics Committee approval, this prospective study screened all adult ICU patients having septic shock within one week of onset. Those with normal liver function test (LFT) and normal liver echogenicity on ultrasonography before onset of shock were considered for inclusion. Exclusion criteria were: known liver disease, congestive heart failure, raised intraabdominal pressure and recent abdominal surgeries. All included patients underwent liver stiffness assessment by 2D SWE technique between days 2 and 7 after the onset of septic shock, which was performed by an experienced radiologist using Aixplorer®, Super Sonic Imagine (Aix-en-Provence, France) with XC6-1 (Single Crystal Curved) convex probe as per recommendations from the World Federation for Ultrasound in Medicine and Biology guidelines published in 2018 [2]. The normal range is 2-7 kPa, highest possible value is 75 kPa. RESULTS: During the study period (Jun-Nov 2023), 104 patients screened, and 17 patients met eligibility criteria. At ICU admission, included 17 patients had median age of 37 years (IQR 18-78) and 53% were females, Charlsons comorbidity index was 4 (IQR 0-6) and SOFA score was 8 (IQR 1-14). At inclusion, median day of septic shock duration was 6 (IQR 2-7) with median SOFA score 7 (IQR 3-11). The median vasopressor cumulative dose at the time of assessment was 120.4 × 10(3) mcg (IQR 7.84-220 × 10(3)mcg). The liver stiffness was elevated in all patients with a median value of 30.4 kPa (IQR 16.3-65). DISCUSSION: The measurement of liver stiffness is being routinely done for diagnosis of liver diseases and is well accepted in non-ICU patients for the diagnosis and grading of cirrhosis, acute and chronic hepatitis. So far, no study has been done for assessment of liver stiffness in patients having septic shock. Our study is first to explore liver damage assessed by 2D SWE in ICU patients having septic shock which revealed elevated median value of liver stiffness. CONCLUSION: Our study found out that liver stiffness is significantly higher in septic shock patients as measured by 2D SWE.