1016 CHOLESTASIS IN THE TOXIC-SHOCK SYNDROME (TSS)

Abstract

Serum liver function tests were performed in 22 females, fulfilling the criteria for the TSS. Total serum bilirubin at some point during hospitalization was > 1.0 mg/dl in 18/21 pts. Mean (x) and SD during hospitalization were: 2.3±1.3 mg/dl (n=20) on day #1, 3.1±2.7 (n=14) on day #2, and 2.5±2.1 (n=12) on day #3, respectively, with a maximum (max) level of 11.3 mg/dl in one pt. In 8/16 pts tested, the conjugated bilirubin was > 0.4 mg/dl with a range (R) = 0.5−5.3 mg/dl; x = 1.8±1.6 mg/dl.Other abnormalities of liver function on the first hospital day included SGOT > 41 U/L in 15/20 pts, max: 300 U/L, x = 103±99 U/L; SGPT > 40 IU/L in 8/10 pts, max: 267 IU/L, x = 92±83 IU/L, and GGT > 55 U/L in 7/9 pts, max: 231 U/L, x = 112.4±61.5 U/L. Serum albumin was < 3.7 g/dl in 16/19 pts, R = 2.3−4.4 g/dl, x = 3.2±0.6 g/dl. Alkaline phosphatase during hospitalization was > 101 U/L in 13/19 pts.Serum bile salts (BS) were > 10 μMolar in 16/16 pts, R = 12.2 − 147.7, x = 37.8±37.4. These abnormal values for BS are particularly striking, as all pts were essentially fasting.The 7 pts who required dopamine had significantly higher total serum bilirubin levels during the first two hospital days (t-test of p < .005 and p < .05, respectively). These findings are best explained by both hypoperfusion of the liver and a canalicular injury secondary to staphylococcal exotoxin. Cholestatic features appear to be a universal finding in TSS.