- Patients presenting to emergency departments (EDs) with septic shock and end-stage liver disease (ESLD) are likelier to die than those without liver disease.
- Higher lactate and pneumonia may aid in risk stratification.
- Lactate screening may reveal “cryptic shock” in this population.
Why this matters
- Not enough is known about sepsis in this population, which is often excluded from trials.
- Baseline metabolic abnormalities, including vasodilation and hyperdynamic circulation, can complicate early sepsis detection.
- 161 (6.2%) patients had ESLD.
- ESLD vs non-ESLD patients had:
- Lower temperature, BP, albumin;
- Higher serum lactate, acute kidney injury incidence; and
- Higher mortality: 36.6% vs 21.2% (P<.001>
- Among ESLD patients:
- 72% were afebrile;
- 69% had lactate ≥4 mmol/L without systemic hypotension; and
- Multiple infection sources were common.
- No between-group differences in antibiotic or fluid administration or sepsis bundle compliance.
- On multivariate analysis, mortality predictors in ESLD patients:
- Pneumonia: OR, 4.8 (P=.02).
- Higher lactate: P=.03.
- Single-centre, 13-ED retrospective review of patients presenting in septic shock (n=2584).
- This centre used a standardised sepsis treatment pathway.
- Outcomes: clinical and treatment variables in patients with ESLD vs without; survivors vs nonsurvivors in ESLD subgroup.
- Funding: None.
- Single, nonmasked reviewer.