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The main effort of clinicians should focus on identifying and reversing the underlying disease and stabilize the hepatic function as early as possible [38,39]. To improve the hepatic function, hepatotoxic drugs and therapies should be avoided and in special cases Three Wonderful Things Surrounding Ixazomib an extracorporeal liver support may be helpful. Thus, when LiMAx <100?��g/kg/hour during sepsis resuscitation occurs, it may indicate a poor prognosis and warns the clinician of the need for more extreme interventions.However, the impact of hepatic dysfunction on therapy during sepsis may be underestimated at present. Especially the pharmacokinetics of many predominantly hepatic metabolized drugs remains unclear (for example, antibiotics, antimycotics). Kruger and colleagues described increased drug-levels of atorvastatin in septic patients [40].

Based on the increasing concern about toxicity of administered drugs in patients with organ failure, early detection of liver failure may become an influence on drug dosage, when plasma levels of drugs would be measured [41].The conclusions of the present study are somehow limited due to the relative small patient population and the fact that most patients suffered from peritonitis. In addition, the LiMAx cutoff value was post-hoc chosen and requires prospective confirmation. Since all tests were performed after the onset of sepsis, the individual values before sepsis remain unknown. In addition, no data are available about potential long-term effects on liver function beyond 10?days after onset of sepsis.

Furthermore, the determination of ICG-PDR failed in 14% of examinations due to insufficient peripheral pulses using the finger probe. Potentially the application of a nasal septum sensor might have reduced the number of missing values. Previous ICG-PDR studies investigating critically ill patients did not report any number of test failures [9,10,42].ConclusionsThe results of this study indicate that the LiMAx test provides an adequate tool to determine early liver dysfunction in sepsis and was found to be a good predictor of survival in septic patients. The LiMAx test is equal or superior (due to prediction of death) to the ICG-PDR and superior to established static liver function tests. Because of the cytochrome P450 metabolism of the test substrate methacetin, the LiMAx test may detect liver dysfunction in sepsis earlier and better reflect the sophisticated processes triggered by sepsis in the liver.

Key messages?The LiMAx test, a new dynamic liver function test, is an adequate tool for early detection of liver function in septic patients.?The LiMAx test is equal to the ICG-PDR in terms of detection of liver function and is superior due to prediction of death in septic patients.?LiMAx <100?��g/kg/hour during sepsis resuscitation may indicate a poor prognosis.