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Hypoxic hepatitis: underlying conditions and risk factors for mortality in critically ill patients

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Abstract

Purpose

Hypoxic hepatitis (HH) is a frequent cause of acute hepatocellular damage at the intensive care unit. Although mortality is reported to be high, risk factors for mortality in this population are unknown.

Methods

One-hundred and seventeen consecutive patients with HH were studied prospectively at three medical intensive care units of a university hospital.

Results

The main causes of hypoxic hepatitis were low cardiac output and septic shock, and most patients (74%) had more than one underlying factor. Peak aspartate transaminase (P = 0.02), lactate dehydrogenase (P = 0.03), INR (P < 0.001) and lactate (P < 0.01) were higher in non-survivors. Prolonged duration of HH caused higher overall mortality rate (P = 0.03). INR > 2 (P = 0.02), septic shock (P = 0.01) and SOFA score >10 (P = 0.04) were risk factors of mortality in the regression model.

Conclusions

Hypoxic hepatitis is the consequence of multiorgan injury. Outcome is influenced by the severity of liver impairment and the etiology and severity of the basic disease.

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Abbreviations

HH:

Hypoxic hepatitis

ICU:

Intensive care unit

AST:

Serum aspartate transaminase level

ALT:

Serum alanine transaminase level

LDH:

Lactate dehydrogenase level

INR:

International normalized ratio

SAPS:

Simplified acute physiology score

SOFA:

Sequential organ failure assessment

IQR:

Interquartile range

CI:

Confidence interval

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Acknowledgments

There was no financial support for this study.

Author information

Authors and Affiliations

  1. Intensive Care Unit 13H1, Department of Gastroenterology and Hepatology, Internal Medicine 3, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria

    Valentin Fuhrmann, Nikolaus Kneidinger, Reinhard Kitzberger, Joanna Warszawska, Ulrike Holzinger, Peter Schenk & Christian Madl

  2. Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria

    Harald Herkner

  3. Intensive Care Unit 13H3, Department of Cardiology, Internal Medicine 2, Medical University of Vienna, Vienna, Austria

    Gottfried Heinz & Mariam Nikfardjam

  4. Intensive Care Unit 13I2, Internal Medicine 1, Medical University of Vienna, Vienna, Austria

    Anja Bojic & Peter Schellongowski

  5. Department of Gastroenterology and Hepatology, Internal Medicine 3, Medical University of Vienna, Vienna, Austria

    Bernhard Angermayr

Authors
  1. Valentin Fuhrmann
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  2. Nikolaus Kneidinger
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  3. Harald Herkner
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  4. Gottfried Heinz
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  7. Peter Schellongowski
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  9. Reinhard Kitzberger
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  10. Joanna Warszawska
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  11. Ulrike Holzinger
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  12. Peter Schenk
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  13. Christian Madl
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Corresponding author

Correspondence to Valentin Fuhrmann.

Additional information

The study was performed at the intensive care units 13H1, 13H3 and 13I2 of the Medical University of Vienna.

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Fuhrmann, V., Kneidinger, N., Herkner, H. et al. Hypoxic hepatitis: underlying conditions and risk factors for mortality in critically ill patients. Intensive Care Med 35, 1397–1405 (2009). https://doi.org/10.1007/s00134-009-1508-2

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  • DOI: https://doi.org/10.1007/s00134-009-1508-2

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