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Interaktionen von Leber und Lunge

Hepatopulmonary interactions

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Zusammenfassung

Interaktionen von Leber und Lunge sind im Alltag häufig präsent und von alltäglicher klinischer Relevanz, obwohl sie oft nicht im Fokus der klinischen Aufmerksamkeit stehen. So haben 10 % der Patienten mit akut-auf-chronischem Leberversagen und über 30 % der Patienten in fortgeschrittenen Stadien ein respiratorisches Organversagen. Umgekehrt leiden bis zu 20 % der kritisch kranken Patienten an erworbenen Leberfunktionsstörungen während ihres Intensivstationsaufenthalts. Häufig spielen hierbei auch pulmonale Krankheitsbilder eine zentrale Komponente. Ziel dieses Übersichtsartikels ist es, einen Überblick hinsichtlich der klinisch relevanten erworbenen pulmonalen sowie hepatalen Krankheitsbilder sowie der therapeutischen Optionen bei Leber-Lungen-Interaktionen zu vermitteln.

Abstract

Liver–lung interactions are common in daily clinical practice. However, frequently they are not the focus of clinical attention. For example, 10% of patients with acute-on-chronic liver failure and more than 30% of patients with advanced stages of acute-on-chronic liver failure suffer from respiratory failure. Conversely, up to 20% of critically ill patients develop secondary liver failure as a consequence of cardiopulmonary diseases or sepsis during their stay in the intensive care unit. This article provides an overview of clinically relevant liver–lung interactions, consecutively acquired pulmonary and hepatic diseases and the therapeutic implications.

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Literatur

  1. Moreau R, Jalan R, Gines P, Pavesi M, Angeli P, Cordoba J et al (2013) Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology 144:1426–1437

    Article  PubMed  Google Scholar 

  2. Fuhrmann V, Whitehouse T, Wendon J (2018) The ten tips to manage critically ill patients with acute-on-chronic liver failure. Intensive Care Med. https://doi.org/10.1007/s00134-018-5078-z

    Article  PubMed  Google Scholar 

  3. Hübener P, Braun G, Fuhrmann V (2017) Acute-on-chronic liver failure: a diagnostic and therapeutic challenge for intensive care. Med Klin Intensivmed Notfmed. https://doi.org/10.1007/s00063-017-0263-3

    Article  PubMed  Google Scholar 

  4. Rybak D, Fallon M, Krowka M et al (2008) Risk factors and impact of chronic obstructive pulmonary disease in candidates for liver transplantation. Liver Transpl 14:1357–1365

    Article  PubMed  PubMed Central  Google Scholar 

  5. Krowka MJ, Fallon MB, Kawut SM, Fuhrmann V, Heimbach JK, Ramsay MA, Sitbon O, Sokol RJ International Liver Transplant Society Practice Guidelines (2016) Diagnosis and management of hepatopulmonary syndrome and portopulmonary hypertension. Transplantation 100:1440–1452

    Article  PubMed  Google Scholar 

  6. Rutter K, Horvatits T, Drolz A, Roedl K, Siedler S, Kluge S, Fuhrmann V (2018) Acute liver failure. Med Klin Intensivmed Notfmed 113(3):174–183. https://doi.org/10.1007/s00063-016-0156-x

    Article  PubMed  CAS  Google Scholar 

  7. Fuhrmann V, Madl C, Mueller C, Holzinger U, Kitzberger R, Funk GC, Schenk P (2006) Hepatopulmonary syndrome in patients with hypoxic hepatitis. Gastroenterology 131:69–75

    Article  PubMed  Google Scholar 

  8. Fuhrmann V, Krowka M (2018) Hepatopulmonary syndrome. J Hepatol. https://doi.org/10.1016/j.jhep.2018.01.002

    Article  PubMed  Google Scholar 

  9. Swanson KL, Wiesner RH, Krowka MJ (2005) Natural history of hepatopulmonary syndrome: impact of liver transplantation. Hepatology 41:1122–1129

    Article  PubMed  Google Scholar 

  10. Fallon M, Krowka MJ, Brown RS, Trotter JF, Zacks S, Roberts KE et al (2008) Impact of hepatopulmonary syndrome on quality of life and survival in liver transplant candidates. Gastroenterology 135:1168–1175

    Article  PubMed  PubMed Central  Google Scholar 

  11. Schenk P, Schoniger-Hekele M, Fuhrmann V, Madl C, Silberhumer G, Muller C (2003) Prognostic significance of the hepatopulmonary syndrome in patients with cirrhosis. Gastroenterology 125:1042–1052

    Article  PubMed  Google Scholar 

  12. Fritz JS, Fallon MB, Kawut SM (2013) Pulmonary vascular complications of liver disease. Am J Respir Crit Care Med 187:133–143

    Article  PubMed  PubMed Central  Google Scholar 

  13. Raevens S, Fallon M (2018) Potential targets in hepatopulmonary syndrome: lessons from experimental models. Hepatology. https://doi.org/10.1002/hep.30079

    Article  PubMed  Google Scholar 

  14. Horvatits T, Fuhrmann V (2014) Therapeutic options in pulmonary hepatic vascular diseases. Expert Rev Clin Pharmacol 7:31–42

    Article  PubMed  CAS  Google Scholar 

  15. Swanson KL, Wiesner RH, Nyberg SL, Rosen CB, Krowka MJ (2008) Survival in portopulmonary hypertension: Mayo Clinic experience categorized by treatment subgroups. Am J Transplant 8:2445–2453

    Article  PubMed  CAS  Google Scholar 

  16. Le Pavec J, Souza R, Herve P, Lebrec D, Savale L, Tcherakian C et al (2008) Portopulmonary hypertension: survival and prognostic factors. Am J Respir Crit Care Med 178:637–643

    Article  PubMed  Google Scholar 

  17. Fuhrmann V, Kramer L, Bauer E, Laferl H, Tucek G, Dekan G, Schenk P (2004) Severe interstitial pneumonitis secondary to pegylated interferon alpha-2b and ribavirin treatment of hepatitis C infection. Dig Dis Sci 49:1966–1970

    Article  PubMed  Google Scholar 

  18. Gerbes AL, Gulberg V, Sauerbruch T, Wiest R, Appenrodt B, Bahr MJ et al (2011) German S 3‑guideline “ascites, spontaneous bacterial peritonitis, hepatorenal syndrome”. Z Gastroenterol 49:749–779

    Article  PubMed  CAS  Google Scholar 

  19. Kiafar C, Gilani N (2008) Hepatic hydrothorax: current concepts of pathophysiology and treatment options. Ann Hepatol 7:313–320

    PubMed  CAS  Google Scholar 

  20. Dhanasekaran R, West JK, Gonzales PC, Subramanian R, Parekh S, Spivey JR et al (2010) Transjugular intrahepatic portosystemic shunt for symptomatic refractory hepatic hydrothorax in patients with cirrhosis. Am J Gastroenterol 105:635–641

    Article  PubMed  Google Scholar 

  21. Drolz A, Horvatits T, Roedl K, Fuhrmann V (2014) Shock liver and cholestatic liver in critically ill patients. Med Klin Intensivmed Notfmed 109:228–234

    Article  PubMed  CAS  Google Scholar 

  22. Fuhrmann V, Jäger B, Zubkova A, Drolz A (2010) Hypoxic hepatitis—epidemiology, pathophysiology and clinical management. Wien Klin Wochenschr 122:129–139

    Article  PubMed  Google Scholar 

  23. Fuhrmann V, Kneidinger N, Herkner H, Heinz G, Nikfardjam M, Bojic A, Schellongowski P, Angermayr B, Kitzberger R, Warszawska J, Holzinger U, Schenk P, Madl C (2009) Hypoxic hepatitis: underlying conditions and risk factors for mortality in critically ill patients. Intensive Care Med 35:1397–1405

    Article  PubMed  Google Scholar 

  24. Fuhrmann V, Kneidinger N, Herkner H, Heinz G, Nikfardjam M, Bojic A, Schellongowski P, Angermayr B, Schöniger-Hekele M, Madl C, Schenk P (2011) Impact of hypoxic hepatitis on mortality in the intensive care unit. Intensive Care Med 37:1302–1310

    Article  PubMed  Google Scholar 

  25. Drolz A, Horvatits T, Roedl K, Rutter K, Staufer K, Haider DG, Zauner C, Heinz G, Schellongowski P, Kluge S, Trauner M, Fuhrmann V (2016) Outcome and features of acute kidney injury complicating hypoxic hepatitis at the medical intensive care unit. Ann Intensive Care 6:61

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  26. Recknagel P, Gonnert FA, Westermann M, Lambeck S, Lupp A, Rudiger A, Dyson A, Carré JE, Kortgen A, Krafft C, Popp J, Sponholz C, Fuhrmann V, Hilger I, Claus RA, Riedemann NC, Wetzker R, Singer M, Trauner M, Bauer M (2012) Liver dysfunction and phosphatidylinositol-3-kinase signalling in early sepsis: experimental studies in rodent models of peritonitis. Plos Med 9:e1001338

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  27. Jäger B, Drolz A, Michl B, Schellongowski P, Bojic A, Nikfardjam M, Zauner C, Heinz G, Trauner M, Fuhrmann V (2012) Jaundice increases the rate of complications and one-year mortality in patients with hypoxic hepatitis. Hepatology 56:2297–2304

    Article  PubMed  CAS  Google Scholar 

  28. Rutter K, Horvatits T, Drolz A et al (2018) Acute liver failure. Med Klin Intensivmed Notfmed 113:174–183

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland

    V. Fuhrmann & P. Tariparast

  2. Medizinische Klinik B, Universitätsklinikum Münster, Münster, Deutschland

    V. Fuhrmann

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  1. V. Fuhrmann
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Correspondence to V. Fuhrmann.

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Interessenkonflikt

V. Fuhrmann und P. Tariparast geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Redaktion

U. Janssens, Eschweiler

W. Druml, Wien

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Fuhrmann, V., Tariparast, P. Interaktionen von Leber und Lunge. Med Klin Intensivmed Notfmed 113, 464–469 (2018). https://doi.org/10.1007/s00063-018-0473-3

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  • DOI: https://doi.org/10.1007/s00063-018-0473-3

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