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Hypoxic hepatitis in critically ill patients: incidence, etiology and risk factors for mortality

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Abstract

Purpose

Hypoxic hepatitis may be induced by hemodynamic instability or arterial hypoxemia in critically ill patients. We investigated the incidence, etiology, association with systemic ischemic injury and risk factors for mortality in this population.

Methods

Retrospective analysis of patients with hypoxic hepatitis admitted to a multidisciplinary intensive care unit (ICU) of a university hospital. Hypoxic hepatitis was defined as the existence of a compatible clinical setting (cardiocirculatory failure or arterial hypoxemia) and aminotransferase levels higher than 1000 IU/L.

Results

During the 8-year study period, 182 out of the 7674 patients admitted presented hypoxic hepatitis (2.4%). The most common cause was septic shock. The rate of in-hospital mortality in hypoxic hepatitis was 61.5% (112 patients), and was higher in patients with septic shock (83.3%) and cardiac arrest (77.7%). Ischemic pancreatitis (25.6%), rhabdomyolysis (41.2%) and renal failure (67.2%) were common in these patients. Risk factors of mortality were prolonged INR (p = 0.005), need for renal replacement therapy (p = 0.001) and septic shock (p = 0.005).

Conclusions

Hypoxic hepatitis was not a rare condition, and was frequently accompanied by multiorgan injury, with high mortality. Risk factors for increased mortality were prolonged INR, need for renal replacement therapy, and septic shock.

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Conflict of interest

All authors declare no conflict of interest.

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Authors and Affiliations

  1. Servei de Medicina Intensiva, Hospital Universitari Son Dureta, c/ Andrea Doria 55, 07014, Palma de Mallorca, Illes Balears, Spain

    Joan M. Raurich, Juan Antonio Llompart-Pou, Mireia Ferreruela, Asunción Colomar, Maria Molina, Cristina Royo, Ignacio Ayestarán & Jordi Ibáñez

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  1. Joan M. Raurich
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  2. Juan Antonio Llompart-Pou
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  3. Mireia Ferreruela
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  4. Asunción Colomar
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  5. Maria Molina
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  6. Cristina Royo
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  7. Ignacio Ayestarán
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  8. Jordi Ibáñez
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Correspondence to Joan M. Raurich.

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Raurich, J.M., Llompart-Pou, J.A., Ferreruela, M. et al. Hypoxic hepatitis in critically ill patients: incidence, etiology and risk factors for mortality. J Anesth 25, 50–56 (2011). https://doi.org/10.1007/s00540-010-1058-3

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  • DOI: https://doi.org/10.1007/s00540-010-1058-3

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