Improved diagnosis of sepsis-related hepatic dysfunction with the LiMAx test
Prospective study showed superior sensitivity and specificity of the LiMAx test compared to traditional tests and its value as predictor of survival
Sepsis is a frequent infection with high mortality rates in intensive care units (ICU) and may occur in approximately 25% of ICU patients. Multiple organ failure caused by sepsis still remains the most frequent cause of death in intensive care. Hepatic dysfunction and liver failure deriving from severe sepsis might be associated with poor prognosis in critically ill patients. A prospective clinical study showed that sepsis-related hepatic dysfunction can be diagnosed early and effectively by the LiMAx test. The extent of LiMAx impairment is predictive for patient morbidity and mortality. The sensitivity and specificity of the LiMAx test was superior to that of the indocyanine green test regarding the prediction of survival.
Erwin de Buijzer, Managing Director of Humedics GmbH, comments the positive study results: “In this study, our LiMAx breath test was investigated for the diagnosis of sepsis-related liver dysfunction for the first time and the results show that the test provides an early and more precise diagnosis for these critically ill patients. We are pleased that we can extend the indications for this new and sophisticated diagnostic tool and expect that the LiMAx test will find its way into the intensive care for improved diagnosis and treatment of sepsis patients.”
Study results clearly showed that septic shock leads to deterioration of LiMAx within two days after onset of sepsis in the vast majority of patients. Furthermore, the degree of functional impairment determined by the LiMAx test is closely related with the patient’s prognosis. In addition, follow up LiMAx allowed the determination of individual progress of the patients. PD Dr. Martin Stockmann from Charité – Universitätsmedizin Berlin at the Campus Virchow Hospital, Dept. of General, Visceral and Transplantation Surgery, explains: “The LiMAx test directly measures the liver function via the capacity of the liver specific cytochrome P450 enzyme system and thus provides reliable results on the metabolic capacity of the liver. This has not been possible until now with other tests described.” Stockmann assumes that the impact of hepatic dysfunction on therapy during sepsis may be underestimated at present. With respect to the potential toxicity of administered drugs in patients with organ failures, he concludes: “Therapy schemes and drug dosage may be adapted due to the liver function capacity. This could lead to an optimized therapy of the patient in this critical situation”
28 patients suffering from sepsis on a surgical ICU were investigated prospectively. All patients received routine sepsis therapy according to current sepsis guidelines (surgery, fluids, catecholamines, antibiotic drugs). The first LiMAx test was carried out within the first 24 hours after onset of septic symptoms, followed by day 2, 5 and 10. Other biochemical parameters and scores determining the severity of illness were measured daily. Clinical outcome parameters were examined after 90 days or at the end of treatment. The population was divided into 2 groups (group A: non- survivors or ICU length of stay (ICU-LOS) >30 days versus group B: survivors and ICU-LOS <30 days) for analysis.
The study was performed at Charité – Universitätsmedizin Berlin, Campus Virchow Hospital, Dept. of General, Visceral and Transplantation Surgery.
Original publication: Critical Care 2013, 17:R259 doi:10.1186/cc13089
Based in Berlin, Germany, Humedics GmbH is specialised in rapid and accurate liver function measurement using LiMAx®, an innovative technology for analysing exhaled air. The LiMAx® test provides physicians with a method for quantitatively assessing an individual patient’s liver function capacity within minutes. This enables physicians to select treatment strategies and follow disease progression based on up-to-date knowledge of the functional health of the liver.
Current applications, which have already been published in prestigious medical journals, include liver function diagnosis before and after liver transplantation, surgical planning for liver surgery (such as assessing how much liver tissue can be removed without increasing the risk of acute liver failure), and assessment of liver diseases such as fibrosis and cirrhosis. At present, more than 20 studies regarding new indications are being conducted. These include diagnosing and staging of chronic liver diseases such as non-alcoholic steatohepatitis (NASH), as well as selecting, monitoring and managing different oncology treatment options.
These studies, initiated by researchers, have already provided evidence of further potential for the LiMAx® tests. The LiMAx® test is in routine clinical use at more than 30 leading university hospitals in Europe. So far, more than 20,000 LiMAx® tests have been performed. The LiMAx® test is commercially available in Germany, Austria and the UK.