PMC7987411_01
LiMAx  values in comparison to the MELD-Score calculated from conventional liver parameters over the course of treatment and the caspofungin-, tigecycline-, and linezolid-dose administered. Note that CVVHD in combination with CytoSorb  hemoadsorption was restarted at hospital day 22. Linezolid dose should be multiplied by a factor of ten for reasons of better representability.
CRICC2021-8824050.001.jpg
PMC7987411_01_CRICC2021-8824050.001.jpg
fig1
The dynamic maximum liver function capacity test (LiMAx ) showed a value of 57 mug/kg/h, indicating severe liver insufficiency (Figure 1). The LiMAx  measurement another 8 days later showed a stable, but still medium-gross restricted hepatic function (136 mug/kg/h) (Figure 1).
Ammonia, bilirubin, and interleukin 6 serum concentrations as well as norepinephrine dosage over time as well as hemoadsorption with CytoSorb   starting on hospital day 15 and 22.
CRICC2021-8824050.002.jpg
PMC7987411_01_CRICC2021-8824050.002.jpg
fig2
This was also done to eliminate liver metabolites, such as bilirubin, ammonia, and bile acids in the context of sepsis-associated acute liver failure (Figure 2). With maximum interdisciplinary care (laparotomy, CRRT, liver and ventilation support, pericardial drainage, antimicrobial therapy, etc.), the hyperinflammatory response was declining which resulted in a marked decrease in vasopressor requirements (reduction of vasopressor support to 16.9% of the maximum initial dose, respectively) and a normalization in bilirubin levels (Figure 2) accompanied by the onset of diuresis. Inflammatory parameters improved consistently over the course of the next week (Figure 2).
LiMAX  measurement protocols.
CRICC2021-8824050.003.jpg
PMC7987411_01_CRICC2021-8824050.003.jpg
fig3
The dose was reduced accordingly (Figure 3).