Pathophysiology of sepsis‐induced cholestasis: A review

Abstract

Sepsis is a critical condition resulting from the excessive activation of the inflammatory/immune system in response to an infection, with high mortality if treatment is not administered promptly. One of the many possible complications of sepsis is liver dysfunction with consequent cholestasis. The aim of this paper is to review the main mechanisms involved in the development of cholestasis in sepsis. Cholestasis in a septic patient must raise the suspicion that it is the consequence of the septic condition and limit the laborious attempts of finding a hepatic or biliary disease. Prompt antibiotic administration when sepsis is suspected is essential and may improve liver enzymes. Cholestasis is a syndrome with a variety of etiologies, among which sepsis is frequently overlooked, despite a number of studies and case reports in the literature demonstrating not only the association between sepsis and cholestasis but also the role of cholestasis as a prognostic factor for sepsis‐induced death.

Mitochondrial Diabetes Mellitus with Mitochondrial DNA 3316G>A Mutation: A Unique Autopsy Case Presenting with Sepsis-Associated Cholestasis

“…Although jaundice with hyperbilirubinemia is a frequent symptom in the intensive care unit with incidence up to 40% among critically ill patients [8, 9], sepsis-associated cholestasis could not be a common feature for both clinicians and pathologists. However, it has been described that cholestasis is a possible complication in septic patients with extrahepatic Gram-negative bacterial infection [10,11], as in the present autopsy case. We should be aware that, in particular, the septic patients with aggressive jaundice and conjugated hyperbilirubinemia undergo a fatal condition with very poor prognosis [11].…”

Cholestatic drug induced liver injury in active pulmonary tuberculosis patient: a case report

“…The presence of cholestasis also known to induce sepsis in several reported cases due to hypoxic hepatitis and impairment of bile transport, hence worsening the condition of the patient. 16 Due to the history of relapse case and slow recovery rate despite receiving ATT for 4 weeks, we suspected the possibility of drug resistant tuberculosis in our patient. Drug susceptibility test was negative but not eliminating the possibility of false negative.…”

Acute Sepsis-Induced Cholestatic Disease Presenting With Isolated Hyper-Bilirubinemia

“…Although the overall incidence of cholestasis in critically ill patients seems to be around 33%, several etiologies couldd lead to it [ 5 ]. The two main mechanisms arise from bile acids and bilirubin uptake and transport impairment due to hypoxia and hypoperfusion, and/or due to inflammatory cytokines and endotoxins that negatively impact the function of the biliary cells and hepatocytes [ 8 ]. A combination of laboratory abnormalities in sepsis-induced cholestasis has been reported.…”

“…A combination of laboratory abnormalities in sepsis-induced cholestasis has been reported. Although alanine transaminase (ALT), aspartate transaminase (AST), and alkaline phosphatase (ALP) may be normal or elevated, conjugated bilirubin is always elevated which reflects intrahepatic cholestasis [ 8 ]. In this case report, we witnessed elevated hyperbilirubinemia and ALP with cholestasis of sepsis that improved with targeted antibiotic therapy.…”