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Leberwerterhöhung auf der Intensivstation

Abnormal liver function tests in the intensive care unit

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Zusammenfassung

Leberwerterhöhungen finden sich regelhaft bei der Mehrzahl der intensivmedizinisch behandelten Patienten und sind mit einer signifikant erhöhten Letalität assoziiert. Häufige Ursachen für die Erhöhung sind akute hepatologische Krankheitsbilder, wie z. B. akute Hepatitis, akutes Leberversagen oder Medikamententoxizität. Davon abzugrenzen sind Dekompensationen vorbestehender Lebererkrankungen (akut-auf-chronisch) und sekundäre Leberschädigungen im Sinne einer ischämischen oder hypoxischen Hepatitis, die im Rahmen kritischer Erkrankungen wie Sepsis, Rechtsherzdekompensation oder kardiogenem Schock entstehen. Leberwerterhöhungen können auch Komplikationen intensivmedizinischer Therapien anzeigen, wie beispielsweise aufgrund einer Medikamententoxizität, sekundär sklerosierenden Cholangitis (SC-CIP) oder unter parenteraler Ernährung. Für die Therapie ist es entscheidend, die Ursache der Leberwerterhöhung durch einen strukturierten diagnostischen Algorithmus korrekt einzuschätzen, um dann die zugrundeliegende Problematik adäquat zu behandeln.

Abstract

Abnormal liver biochemical and function tests are found in the majority of critically ill patients and are associated with increased mortality. Frequent causes for elevated liver function tests in the intensive care unit (ICU) are acute hepatic dysfunction due to acute hepatitis, acute liver failure (ALF), and drug-induced liver injury (DILI). Furthermore, exacerbations of pre-existing liver diseases (acute on chronic) and secondary liver injury during critical diseases such as sepsis, right heart failure, or cardiogenic shock, resulting in ischemic or hypoxic hepatitis, need to be considered. Elevated liver enzymes may also reflect a complication of ICU treatment measures like drug-related hepatotoxicity, secondary sclerosing cholangitis in critically ill patients (SC-CIP), or related to parenteral nutrition. Comprehensive diagnostic evaluation is essential to identify the underlying etiology of abnormal liver function tests and to initiate the appropriate therapeutic strategies.

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Literatur

  1. Thomson SJ, Cowan ML, Johnston I et al (2009) ‚Liver function tests‘ on the intensive care unit: a prospective, observational study. Intensive Care Med 35(8):1406–1411

    Article  PubMed  CAS  Google Scholar 

  2. Penndorf V, Saner F, Gerken G, Canbay A (2012) Liver Parameters in Intensive Care Medicine. Zentralbl Chir (Epub ahead of print)

  3. Cornberg M, Protzer U, Petersen J et al (2011) Prophylaxis, diagnosis and therapy of hepatitis B virus infection – the German guideline. Z Gastroenterol 49(7):871–930

    Article  PubMed  CAS  Google Scholar 

  4. Grau T, Bonet A, Rubio M et al (2007) Liver dysfunction associated with artificial nutrition in critically ill patients. Crit Care 11(1):R10

    Article  PubMed  Google Scholar 

  5. Canbay A, Tacke F, Hadem J et al (2011) Acute liver failure: a life-threatening disease. Dtsch Arztebl Int 108(42):714–720

    PubMed  Google Scholar 

  6. Chalasani N, Fontana RJ, Bonkovsky HL et al (2008) Causes, clinical features, and outcomes from a prospective study of drug-induced liver injury in the United States. Gastroenterology 135(6):1924–1934, 1934 e1921–e1924

    Article  PubMed  Google Scholar 

  7. Hadem J, Tacke F, Bruns T et al (2012) Etiologies and outcomes of acute liver failure in Germany. Clin Gastroenterol Hepatol 10(6):664–669.e662

    Article  PubMed  Google Scholar 

  8. Chalasani N, Bjornsson E (2010) Risk factors for idiosyncratic drug-induced liver injury. Gastroenterology 138(7):2246–2259

    Article  PubMed  CAS  Google Scholar 

  9. Bjornsson E (2006) Drug-induced liver injury: Hy’s rule revisited. Clin Pharmacol Ther 79(6):521–528

    Article  PubMed  Google Scholar 

  10. Davern TJ (2012) Drug-induced liver disease. Clin Liver Dis 16(2):231–245

    Article  PubMed  Google Scholar 

  11. Sands KE, Bates DW, Lanken PN et al (1997) Epidemiology of sepsis syndrome in 8 academic medical centers. JAMA 278(3):234–240

    Article  PubMed  CAS  Google Scholar 

  12. Angus DC, Linde-Zwirble WT, Lidicker J et al (2001) Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 29(7):1303–1310

    Article  PubMed  CAS  Google Scholar 

  13. Koch A, Horn A, Duckers H et al (2011) Increased liver stiffness denotes hepatic dysfunction and mortality risk in critically ill non-cirrhotic patients at a medical ICU. Crit Care 15(6):R266

    Article  PubMed  Google Scholar 

  14. Lautt WW (1985) Mechanism and role of intrinsic regulation of hepatic arterial blood flow: hepatic arterial buffer response. Am J Physiol 249(5 Pt 1):G549–G556

    PubMed  CAS  Google Scholar 

  15. Koskinas J, Gomatos IP, Tiniakos DG et al (2008) Liver histology in ICU patients dying from sepsis: a clinico-pathological study. World J Gastroenterol 14(9):1389–1393

    Article  PubMed  CAS  Google Scholar 

  16. Birrer R, Takuda Y, Takara T (2007) Hypoxic hepatopathy: pathophysiology and prognosis. Intern Med 46(14):1063–1070

    Article  PubMed  Google Scholar 

  17. Henrion J, Schapira M, Luwaert R et al (2003) Hypoxic hepatitis: clinical and hemodynamic study in 142 consecutive cases. Medicine 82(6):392–406

    Article  PubMed  Google Scholar 

  18. Fuhrmann V, Kneidinger N, Herkner H et al (2011) Impact of hypoxic hepatitis on mortality in the intensive care unit. Intensive Care Med 37(8):1302–1310

    Article  PubMed  Google Scholar 

  19. Henrion J, Colin L, Schmitz A et al (1993) Ischemic hepatitis in cirrhosis. Rare but lethal. J Clin Gastroenterol 16(1):35–39

    Article  PubMed  CAS  Google Scholar 

  20. Kramer L, Jordan B, Druml W et al (2007) Incidence and prognosis of early hepatic dysfunction in critically ill patients – a prospective multicenter study. Crit Care Med 35(4):1099–1104

    Article  PubMed  Google Scholar 

  21. Trauner M, Meier PJ, Boyer JL (1998) Molecular pathogenesis of cholestasis. N Engl J Med 339(17):1217–1227

    Article  PubMed  CAS  Google Scholar 

  22. Moseley RH (2004) Sepsis and cholestasis. Clin Liver Dis 8(1):83–94

    Article  PubMed  Google Scholar 

  23. Assimakopoulos SF, Scopa CD, Vagianos CE (2007) Pathophysiology of increased intestinal permeability in obstructive jaundice. World J Gastroenterol 13(48):6458–6464

    Article  PubMed  CAS  Google Scholar 

  24. Dellinger RP, Levy MM, Rhodes A et al (2013) Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 41(2):580–637

    Article  PubMed  Google Scholar 

  25. Roma MG, Toledo FD, Boaglio AC (2011) Ursodeoxycholic acid in cholestasis: linking action mechanisms to therapeutic applications. Clin Sci (Lond) 121(12):523–544

    Google Scholar 

  26. Cameron AM, Busuttil RW (2005) Ischemic cholangiopathy after liver transplantation. Hepatobiliary Pancreat Dis Int 4(4):495–501

    PubMed  Google Scholar 

  27. Gelbmann CM, Rummele P, Wimmer M et al (2007) Ischemic-like cholangiopathy with secondary sclerosing cholangitis in critically ill patients. Am J Gastroenterol 102(6):1221–1229

    Article  PubMed  Google Scholar 

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Einhaltung ethischer Richtlinien

Interessenkonflikt. A. Koch, K. Streetz, J. Tischendorf, C. Trautwein und F. Tacke geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Medizinische Klinik III, Gastroenterologie, Stoffwechselerkrankungen und Internistische Intensivmedizin, Universitätsklinikum der RWTH Aachen, Pauwelsstr. 30, 52072, Aachen, Deutschland

    A. Koch, K. Streetz, J. Tischendorf, C. Trautwein & F. Tacke

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  1. A. Koch
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  2. K. Streetz
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  3. J. Tischendorf
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  4. C. Trautwein
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  5. F. Tacke
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Correspondence to A. Koch.

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Widmung

Gewidmet Frau Dr. med. Wiebke Kaestner.

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Koch, A., Streetz, K., Tischendorf, J. et al. Leberwerterhöhung auf der Intensivstation. Med Klin Intensivmed Notfmed 108, 599–610 (2013). https://doi.org/10.1007/s00063-013-0287-2

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  • DOI: https://doi.org/10.1007/s00063-013-0287-2

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