Liver Injury and Failure in Critical Illness

Abstract

The frequency of acquired liver injury and failure in critical illness has been significantly increasing over recent decades. Currently, liver injury and failure are observed in up to 20% of patients in intensive care units and are associated with significantly increased morbidity and mortality. Secondary forms of liver injury in critical illness are divided primarily into cholestatic, hypoxic, or mixed forms. Therefore, sufficient knowledge of underlying alterations (e.g., hemodynamic, inflammatory, or drug induced) is key to a better understanding of clinical manifestations, prognostic implications, as well as diagnostic and therapeutic options of acquired liver injury and failure. This review provides a structured approach for the evaluation and treatment of acquired liver injury and failure in critically ill patients.

HsCRP Variation is the Main Risk Factor for Clinical Outcome in COVID-19 Hospitalized Young and Middle-Aged Patients

“…There may be two reasons for explaining the negative value of hsCRP variation in the elderly patients admitted to ICU. On the one hand, the elderly patients admitted to ICU experienced more severe dissociation of bilirubin and enzyme, suggesting more impairment of hepatic cells and lessor liver function reservation than young and middleaged patients, which resulted in reduced hsCRP production (18,19). In ICU patients, the elderly patients showed signi cantly lower ALT (median, 320 vs 38, P < 0.01) and higher TBIL (median, 11.2 vs 9.5, P < 0.01) than the young and middle-aged patients, suggesting more severe dissociation of bilirubin and enzyme in the elderly patients.…”

The persistent potential of extracorporeal therapies in liver failure

“…A recent European multinational analysis reported an increase from 5 to 20% of all patients treated at the intensive care unit (ICU) [2]. Liver failure is a classical form of multi organ failure as already represented in the diagnostic criteria of its different entities: ALF is defined as defined as onset of hepatic encephalopathy and hepatic coagulopathy (INR > 1.5) in patients without underlying liver disease [3,4]; ACLF is defined as presence of acute hepatic decompensation (i.e. ascites, hepatic encephalopathy, gastrointestinal bleeding or bacterial infection in patients with chronic liver disease) in combination with (mainly extrahepatic multi-)organ failure [5,6].…”

“…ascites, hepatic encephalopathy, gastrointestinal bleeding or bacterial infection in patients with chronic liver disease) in combination with (mainly extrahepatic multi-)organ failure [5,6]. In critical illness all types of liver failure increase morbidity and mortality dramatically [4]. Therapy should focus on prompt removal of the underlying trigger causing the hepatic injury like treatment of cardiac failure, sepsis or gastrointestinal bleeding.…”

“…Therapy should focus on prompt removal of the underlying trigger causing the hepatic injury like treatment of cardiac failure, sepsis or gastrointestinal bleeding. The main therapeutic aim is focused on avoidance of progression of multiorgan failure mainly by symptomatic multimodal treatment with bundles of care [3][4][5] (Fig. 1).…”

“…Incidence of liver injury and failure is increasing in critically ill patients. Most frequently, patients suffer from secondary forms of acute liver failure (hypoxic liver injury and cholestatic liver failure, observed in 5-20% of critically ill patients) followed by acute on chronic liver failure (observed in 2-5% of the ICU-population) and primary acute liver failure (< 10 cases per million persons/year) [4,5]. Definition of treatment goals and repeated evaluation of the patients are of central importance in management of patients with liver failure that receive ECLS.…”