Hepatic dysfunction impairs prognosis in critically ill patients with hematological malignancies: A post-hoc analysis of a prospective multicenter multinational dataset

Bisbal, Magali; Darmon, Michaël; Saillard, Colombe; Mallet, Vincent; Mouliade, Charlotte; Lemiale, Virginie; Benoît, Dominique; Pène, Frédéric; Kouatchet, Achille; Demoule, Alexandre; Vincent, François; Nyunga, Martine; Bruneel, Fabrice; Lebert, Christine; Renault, Anne; Meert, Anne-Pascale; Hamidfar, Rébecca; Jourdain, M.; Azoulay, Élie; Mokart, Djamel

doi:10.1016/j.jcrc.2020.11.023

Cited by 5 publications

(11 citation statements)

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“…Viral infection, toxicity, tumor, and fatty liver would affect liver parenchymal cells and Kupffer cells, and result in liver dysfunction, such as metabolism disorders, imbalance synthesis and degradation of the extracellular matrix (ECM), bile secretion and excretion, and detoxification and immunity. 2 Excessive deposition of ECM means a large amount of collagen deposited in the liver, thus promoting fibrogenesis. 3 Hepatic stellate cells (HSCs) play a critical role in ECM production.…”

Section: Introductionmentioning

confidence: 99%

Protective role of Siberian onions against toxin-induced liver dysfunction: an insight into health-promoting effects

et al. 2022

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Section: Introductionmentioning

confidence: 99%

Protective role of Siberian onions against toxin-induced liver dysfunction: an insight into health-promoting effects

et al. 2022

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“…At D0, 35% were critically ill and required ICU management. The median SOFA score was 6 4–9 . Clinically, almost one‐third of patients presented with hepatomegaly, weight gain, hepatodynia, ascites, fever, or sepsis, and 65% received antimicrobial therapy.…”

Section: Resultsmentioning

confidence: 99%

“…Critically ill patients comprised 35% of our cohort and there are little data available concerning HD in these patients. In the general ICU population, HD is known to have a poor prognostic impact, with a hospital mortality rate of 56%, 5,49 and is associated with performance status and organ dysfunctions (mechanical ventilation, renal replacement therapy, vasopressors and SOFA score). In another cohort of critically ill patients with haematological malignancies 20% developed HD, which was confirmed as an independent risk factor for mortality and occasionally responsible for altering additional cancer treatment 3 .…”

Section: Discussionmentioning

confidence: 99%

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Hepatic haemophagocytosis in haematology patients with hepatic dysfunction: prognostic impact and contribution of liver biopsy combined with the haemophagocytic syndrome diagnostic score (HScore)

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Hepatic dysfunction (HD) is common in patients with haematological malignancies. Hepatic haemophagocytosis (HH) was detected in >50% of liver biopsies taken when HD remained unresolved after standard examination. We aimed to explore the contribution of liver biopsy in patients with both haematological malignancies and HD, describe the population of patients with HH, assess the prognostic impact of HH, and investigate haemophagocytic syndrome diagnostic score (HScore) utility in patients with HH. Between 2016 and 2019, 116 consecutive liver biopsies (76 transjugular, 40 percutaneous) were taken in 110 patients with haematological malignancy and HD (hyperbilirubinaemia, elevated transaminases, and/or cholestasis) and without a clear diagnosis. Liver biopsies were safe and diagnostically efficient. Predominant diagnoses included: HH (56%), graftversus-host disease (55%), associated infections (24%), sinusoidal obstruction syndrome (15%), and tumoral infiltration (8%). Of patients, 35% were critically ill and 74% were allogeneic haematopoietic stem cell transplantation recipients, while 1-year overall survival (OS) was 35% with HH versus 58% without HH (p = 0.026). The 1-year OS was 24% with a HScore of ≥169 versus 50% with a HScore of <169 (p = 0.019). Liver biopsies are feasible in and contribute significantly to haematology patients with HD. HH occurred frequently and was associated with a poor prognosis. Combined with liver biopsy, the HScore may be helpful in refining haemophagocytic syndrome diagnosis.

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“…Bilirubin is a marker of liver dysfunction and a powerful prognostic factor. It has been shown to be linked to infections in surgical patients [ 78 , 79 ], to an increased mortality among trauma patients [ 80 , 81 ], sepsis [ 82 ] or hematological malignancies [ 83 ], to a poor prognosis among ARDS patients [ 84 ], or simply to a worse outcome in the ICU [ 56 , 85 ] (summarized in Table 3 ).…”

Section: Secondary Acquired Liver Injurymentioning

confidence: 99%

Critical care hepatology: definitions, incidence, prognosis and role of liver failure in critically ill patients

et al. 2022

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Organ dysfunction or overt failure is a commonplace event in the critically ill affecting up to 70% of patients during their stay in the ICU. The outcome depends on the resolution of impaired organ function, while a domino-like deterioration of organs other than the primarily affected ones paves the way for increased mortality. “Acute Liver Failure” was defined in the 1970s as a rare and potentially reversible severe liver injury in the absence of prior liver disease with hepatic encephalopathy occurring within 8 weeks. Dysfunction of the liver in general reflects a critical event in “Multiple Organ Dysfunction Syndrome” due to immunologic, regulatory and metabolic functions of liver parenchymal and non-parenchymal cells. Dysregulation of the inflammatory response, persistent microcirculatory (hypoxic) impairment or drug-induced liver injury are leading problems that result in “secondary liver failure,” i.e., acquired liver injury without underlying liver disease or deterioration of preexisting (chronic) liver disease (“Acute-on-Chronic Liver Failure”). Conventional laboratory markers, such as transaminases or bilirubin, are limited to provide insight into the complex facets of metabolic and immunologic liver dysfunction. Furthermore, inhomogeneous definitions of these entities lead to widely ranging estimates of incidence. In the present work, we review the different definitions to improve the understanding of liver dysfunction as a perpetrator (and therapeutic target) of multiple organ dysfunction syndrome in critical care. Graphic Abstract

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Hepatic dysfunction impairs prognosis in critically ill patients with hematological malignancies: A post-hoc analysis of a prospective multicenter multinational dataset

Cited by 5 publications

References 38 publications

Protective role of Siberian onions against toxin-induced liver dysfunction: an insight into health-promoting effects

Protective role of Siberian onions against toxin-induced liver dysfunction: an insight into health-promoting effects

Hepatic haemophagocytosis in haematology patients with hepatic dysfunction: prognostic impact and contribution of liver biopsy combined with the haemophagocytic syndrome diagnostic score (HScore)

Critical care hepatology: definitions, incidence, prognosis and role of liver failure in critically ill patients

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