Original

Intensive Care Medicine

, Volume 37, Issue 8, pp 1302-1310

Impact of hypoxic hepatitis on mortality in the intensive care unit

  • Valentin FuhrmannAffiliated withIntensive Care Unit 13H1, Department of Gastroenterology and Hepatology, Internal Medicine 3, Medical University of Vienna Email author 
  • , Nikolaus KneidingerAffiliated withIntensive Care Unit 13H1, Department of Gastroenterology and Hepatology, Internal Medicine 3, Medical University of Vienna
  • , Harald HerknerAffiliated withDepartment of Emergency Medicine, Medical University of Vienna
  • , Gottfried HeinzAffiliated withIntensive Care Unit 13H3, Department of Cardiology, Internal Medicine 2, Medical University of Vienna
  • , Mariam NikfardjamAffiliated withIntensive Care Unit 13H3, Department of Cardiology, Internal Medicine 2, Medical University of Vienna
  • , Anja BojicAffiliated withIntensive Care Unit 13I2, Internal Medicine 1, Medical University of Vienna
  • , Peter SchellongowskiAffiliated withIntensive Care Unit 13I2, Internal Medicine 1, Medical University of Vienna
  • , Bernhard AngermayrAffiliated withDepartment of Gastroenterology and Hepatology, Internal Medicine 3, Medical University of Vienna
  • , Maximilian Schöniger-HekeleAffiliated withDepartment of Gastroenterology and Hepatology, Internal Medicine 3, Medical University of Vienna
    • , Christian MadlAffiliated withIntensive Care Unit 13H1, Department of Gastroenterology and Hepatology, Internal Medicine 3, Medical University of Vienna
    • , Peter SchenkAffiliated withIntensive Care Unit 13H1, Department of Gastroenterology and Hepatology, Internal Medicine 3, Medical University of Vienna

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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 injury Ischemic hepatitis Shock liver Mortality Vasopressors Epidemiology Outcome