Intensive Care Medicine

, Volume 37, Issue 8, pp 1302–1310

Impact of hypoxic hepatitis on mortality in the intensive care unit

Authors

    • Intensive Care Unit 13H1, Department of Gastroenterology and Hepatology, Internal Medicine 3Medical University of Vienna
  • Nikolaus Kneidinger
    • Intensive Care Unit 13H1, Department of Gastroenterology and Hepatology, Internal Medicine 3Medical University of Vienna
  • Harald Herkner
    • Department of Emergency MedicineMedical University of Vienna
  • Gottfried Heinz
    • Intensive Care Unit 13H3, Department of Cardiology, Internal Medicine 2Medical University of Vienna
  • Mariam Nikfardjam
    • Intensive Care Unit 13H3, Department of Cardiology, Internal Medicine 2Medical University of Vienna
  • Anja Bojic
    • Intensive Care Unit 13I2, Internal Medicine 1Medical University of Vienna
  • Peter Schellongowski
    • Intensive Care Unit 13I2, Internal Medicine 1Medical University of Vienna
  • Bernhard Angermayr
    • Department of Gastroenterology and Hepatology, Internal Medicine 3Medical University of Vienna
  • Maximilian Schöniger-Hekele
    • Department of Gastroenterology and Hepatology, Internal Medicine 3Medical University of Vienna
  • Christian Madl
    • Intensive Care Unit 13H1, Department of Gastroenterology and Hepatology, Internal Medicine 3Medical University of Vienna
  • Peter Schenk
    • Intensive Care Unit 13H1, Department of Gastroenterology and Hepatology, Internal Medicine 3Medical University of Vienna
Original

DOI: 10.1007/s00134-011-2248-7

Cite this article as:
Fuhrmann, V., Kneidinger, N., Herkner, H. et al. Intensive Care Med (2011) 37: 1302. doi:10.1007/s00134-011-2248-7

Abstract

Purpose

Hypoxic hepatitis (HH) is a form of hepatic injury following arterial hypoxemia, ischemia, and passive congestion of the liver. We investigated the incidence and the prognostic implications of HH in the medical intensive care unit (ICU).

Methods

A total of 1,066 consecutive ICU admissions at three medical ICUs of a university hospital were included in this prospective cohort study. All patients were screened prospectively for the presence of HH according to established criteria. Independent risk factors of mortality in this cohort of critically ill patients were identified by a multivariate Poisson regression model.

Results

A total of 118 admissions (11%) had HH during their ICU stay. These patients had different baseline characteristics, longer median ICU stay (8 vs. 6 days, p < 0.001), and decreased ICU survival (43 vs. 83%, p < 0.001). The crude mortality rate ratio of admissions with HH was 4.62 (95% CI 3.63–5.86, p < 0.001). Regression analysis demonstrated strong mortality risk for admissions with HH requiring vasopressor therapy (adjusted rate ratio 4.91; 95% CI 2.51–9.60, p < 0.001), whereas HH was not significantly associated with mortality in admissions without vasopressor therapy (adjusted rate ratio 1.79, 95% CI 0.52–6.23, p = 0.359).

Conclusions

Hypoxic hepatitis (HH) occurs frequently in the medical ICU. The presence of HH is a strong risk factor for mortality in the ICU in patients requiring vasopressor therapy.

Keywords

Hypoxic liver injuryIschemic hepatitisShock liverMortalityVasopressorsEpidemiologyOutcome

Abbreviations

ALT

Serum alanine transaminase

AST

Serum aspartate transaminase

CI

Confidence interval

ICU

Intensive care unit

IQR

Interquartile range

HH

Hypoxic hepatitis

RR

Rate ratio

SAPS

Simplified acute physiology score

Copyright information

© Copyright jointly held by Springer and ESICM 2011