Two-dimensional shear wave elastography-based assessment of liver stiffness in critically ill patients with septic shock: a prospective observational study.

The acute effects of resuscitation on the liver during septic shock, as assessed through liver stiffness, are not well understood. The objective of this pilot study was to evaluate liver stiffness in patients with septic shock using two-dimensional shear wave elastography (2D-SWE). This prospective study was conducted at a 30-bed ICU of a university hospital. Patients with septic shock, who had apparently normal liver status before current illness, requiring vasopressors for ≥ 24 h were considered within 7 days after the onset of shock. Patients with pre-existing liver diseases, congestive heart failure, intra-abdominal hypertension, recent history of abdominal trauma/surgery, body mass index ≥ 35 kg/m2, and pregnancy were excluded. Liver stiffness was measured by 2D-SWE scan, which was repeated after at least 4 weeks of recovery from shock. Fifty-two patients aged 44 (34-63) years in septic shock with median SOFA score 9 (IQR 6-11) were included. The median liver stiffness after the onset of septic shock was 30 kPa (IQR 25.2-34.2), a significantly higher than normal value (< 7 kPa). This stiffness was significantly associated with vasoactive dose index (VDI) [linear regression coefficient (β): 23.02; 95%CI 16.60-29.69; p = 0.001]. The limited follow-up measurements (in 18 survivors) revealed a marked reduction in liver stiffness values from 29 kPa (IQR 26-32) to 6 kPa (IQR 5.4-6.4). Assessment of liver through 2D-SWE, after the onset of septic shock in apparently normal liver status pre-illness, revealed increased stiffness. However, it reverted to normal once clinical condition improved. Clinical Trials Registry - India: CTRI/2023/06/053891.