Hypoxic Hepatitis: A Review and Clinical Update

Abstract

Hypoxic hepatitis (HH), also known as ischemic hepatitis or shock liver, is characterized by a massive, rapid rise in serum aminotransferases resulting from reduced oxygen delivery to the liver. The most common predisposing condition is cardiac failure, followed by circulatory failure as occurs in septic shock and respiratory failure. HH does, however, occur in the absence of a documented hypotensive event or shock state in 50% of patients. In intensive care units, the incidence of HH is near 2.5%, but has been reported as high as 10% in some studies. The pathophysiology is multifactorial, but often involves hepatic congestion from right heart failure along with reduced hepatic blood flow, total body hypoxemia, reduced oxygen uptake by hepatocytes or reperfusion injury following ischemia. The diagnosis is primarily clinical, and typically does not require liver biopsy. The definitive treatment of HH involves correction of the underlying disease state, but successful management includes monitoring for the potential complications such as hypoglycemia, hyperglycemia, hyperammonemia and hepatopulmonary syndrome. Prognosis of HH remains poor, especially for cases in which there was a delay in diagnosis. The in-hospital mortality rate is >50%, and the most frequent cause of death is the predisposing condition and not the liver injury itself.

Acute Liver Failure in a COVID-19 Patient Without any Preexisting Liver Disease

“…3) Ischemic hepatitis, also known as shock liver, is characterized by a significant increase in serum aminotransferases due to reduced oxygen delivery to the liver, usually seen in shock and thromboembolic disease [ 19 ].…”

How to follow-up a patient who received tocilizumab in severe COVID-19: a case report

“…Although we observed full recovery in clinical, radiological and viral terms, some important adverse effects were present during hospitalization and afterwards. In terms of kidney and hepatic injury in the presented patient, it is uncertain whether this was an effect of prescribed treatment (chloroquine, antibiotics and TCZ), hyperinflammation or post-hypoxic organ injury [ 13 – 15 ].…”

Athlete’s Hepatitis in a Young Healthy Marathon Runner

“…Athlete's hepatitis is a pathologic state in which extreme exercise leads to a compromise in the blood supply to the liver resulting in ischemic hypoxic damage. This condition results in transient elevation of liver enzymes which gradually improve in 1–2 weeks with supportive measures in the absence of ongoing hypotension [ 9 ]. The serum bilirubin level usually starts to rise once aminotransferase levels have begun to decline which seems to be the case in our patient.…”

“…Ischemic hepatitis, also known as hypoxic hepatitis, refers to a diffuse hepatic injury resulting from acute hypoperfusion. It is most commonly seen in patients with cardiac or respiratory failure, and in critically ill patients with septic shock, especially in the presence of multiple comorbidities [ 3 ]. Hemodynamic insult leading to liver injury is usually obvious; however, subclinical circulatory disturbances could as well occur in patients with a preexisting passive congestion, diminished hepatic venous outflow, or portal hypertension [ 4 , 5 ].…”