Leberwerterhöhung auf der Intensivstation

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.

Parenteral nutrition: How do patients initiated in the intensive care unit differ from those on the ward?

“…This may be accounted for by severity of illness and higher risk of malnutrition [7] in the ICU cohort. These represent potential latent (confounding) factors [8,9]. The frequency of monitoring is higher in ICU and thus the rate of biochemical events may also reflect this systematic bias.…”

Sekundär sklerosierende Cholangitis bei kritisch Kranken

“…Wichtigste Differenzialdiagnosen sind die medikamentenassoziierte Leberschädigung (drug-induced liver injury, DILI) vom cholestatischen Typ [18,19], sowie die temporäre, endotoxinbedingte Hyperbilirubinämie bei Sepsis [20]. Eine gleichzeitige bestehende bakterielle Cholangitis ist häufig und kann die Differenzialdiagnose weiter verkomplizieren [9,21].…”