Prevalence, clinical characteristics and outcomes of hypoxic hepatitis in critically ill patients

Jonsdottir, Sigrun; Arnardottir, Margret; Andresson, Johannes A.; Björnsson, Helgi; Lund, Sigrún H.; Bjõrnsson, Einar

doi:10.1080/00365521.2021.2005136

Cited by 9 publications

(11 citation statements)

References 27 publications

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“…One of the characteristics of HH is the massive and transient increase in serum transaminase activity caused by hypoxic necrosis of hepatocytes in the centrilobular region. The standard chosen in multiple studies of HH in the ICU involves ALT or AST levels exceeding the upper limit of normal value by 10-20-fold (25)(26)(27)(28)(29). In this study, the inclusion criterion of the HH group was a >10-fold increase to reflect this unique liver injury.…”

mentioning

confidence: 99%

Development and validation of a predictive model for in-hospital mortality in patients with sepsis-associated liver injury

Liu¹,

Sun²,

Jiang³

et al. 2022

Ann Transl Med

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Background: Sepsis is often accompanied by organ dysfunction and acute organ failure, among which the liver is commonly involved. Sepsis patients suffering from liver injury have a greater risk of mortality than patients suffering from general sepsis. As of now, there are no tools that are specifically designed for assessing the prognosis of such patients. This study aimed to develop and validate a model to predict the risk of inhospital mortality in patients with sepsis-associated liver injury (SALI).Methods: Data were obtained from the Medical Information Mart for Intensive Care (MIMIC)-IV database. In the analysis, all patients with SALI who met the inclusion and exclusion criteria were included.A primary outcome was in-hospital mortality, and clinical data were extracted for these patients. In a ratio of 8:2, the data were divided into training and validation groups at random. Least absolute shrinkage and selection operator (LASSO) regression was used for data dimension reduction and feature selection, and independent factors related to prognosis were identified through multi-factor logistics analysis. A nomogram was developed to visualize the model, and the performance of the model was evaluated by the area under the curve (AUC) as well as calibration and decision curve analysis (DCA) through internal verification.Results: A total of 616 and 154 patients with SALI were included in the training and validation cohorts, respectively. The LASSO regression and logistic multivariate analysis showed that nine factors were associated with in-hospital mortality in patients with SALI. Both the training and validation cohorts had higher AUCs than sequential organ failure assessment (SOFA) and simplified acute physiology score 2 (SAPS2): 0.753 (95% CI: 0.715-0.791) and 0.783 (95% CI: 0.749-0.817), respectively. Both the training and validation cohorts showed good calibration results for the prediction model. In terms of clinical practicability, DCA of the predictive model demonstrated greater net benefits than the SOFA and SAPS2 scores. Conclusions:We developed a predictive model that can effectively predict the in-hospital mortality of SALI patients, with satisfactory performance and clinical practicability. This model can assist clinicians in the early identification of high-risk patients and provide a reference for clinical treatment strategies.

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confidence: 99%

Development and validation of a predictive model for in-hospital mortality in patients with sepsis-associated liver injury

Liu¹,

Sun²,

Jiang³

et al. 2022

Ann Transl Med

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“…Adenovirus was found in 75.5% of the cases in England and 50% of the cases in Scotland. The subtyping of 11 cases from the UK revealed that they were all type F41, which was the same subtype found in several of the reported US cases [ 16 ].…”

Section: Introductionmentioning

confidence: 73%

“…Fever, exhaustion, headache, vomiting, nausea, joint problems, and skin rashes are among the symptoms caused by these substances. Because the bile ducts and hepatocytes are damaged in the icteric stage, conjugated bilirubin and transaminases are released into the blood [ 16 ]. The patient appears yellow and produces dark urine because of the conjugated and unconjugated bilirubin.…”

Section: Hepatitismentioning

confidence: 99%

Suspected Adenovirus Causing an Emerging HEPATITIS among Children below 10 Years: A Review

et al. 2022

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In October 2021, a case of acute hepatic failure without any known cause was identified in the United States of America. Upon further investigation, other children aged 1–6 years were reported to have the same liver failure, and some of them were positive for adenovirus 41 type F. On 21 April 2022, the Centers for Disease Control and Prevention (CDC) released an alert after 74 cases were identified in United Kingdom (UK) between 5 and 8 April in children below 10 years of age, some of whom were also found to be positive for SARS-CoV-2. All the patients showed symptoms such as vomiting, diarrhea, jaundice, and abdominal pain. The patients’ liver enzymes were remarkably increased. A total of 650 cases had been reported from 33 countries as of 27 May 2022, among which 222 cases were reported in the UK alone. No connection with SARS-CoV-2 or its vaccine has been found so far. However, the suspected cause is adenovirus, including its genomic variations, because its pathogenesis and laboratory investigations have been positively linked. Until further evidence emerges, hygiene precautions could be helpful to prevent its spread.

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“…Due to the absence of a consensus definition, heterogeneous epidemiological data for secondary liver injury exist. Cholestasis is present in 11–36% of ICU patients [ 9 ], while hypoxic liver injury occurs in 1–18% of cases [ 69 , 70 , 77 ]. For the latter, the incidence increases over 20% in patients with shock [ 75 ].…”

Section: Secondary Acquired Liver Injurymentioning

confidence: 99%

“…For the latter, the incidence increases over 20% in patients with shock [ 75 ]. The overall mortality for secondary acquired liver injury is high, ranging between 27 and 48% for ICU patients with cholestasis [ 56 , 76 ] and between 40 and 60% for hypoxic liver injury [ 9 , 69 , 70 , 72 , 74 , 75 ]. Moreover, in a single-center cohort with 1116 critically ill patients, mortality rates were significantly correlated with the magnitude of transaminases (33.2, 44.4 and 55.4% for peak AST 5–10 × ULN, 10–20 × ULN and > 20 × ULN, respectively) [ 70 ].…”

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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Prevalence, clinical characteristics and outcomes of hypoxic hepatitis in critically ill patients

Cited by 9 publications

References 27 publications

Development and validation of a predictive model for in-hospital mortality in patients with sepsis-associated liver injury

Development and validation of a predictive model for in-hospital mortality in patients with sepsis-associated liver injury

Suspected Adenovirus Causing an Emerging HEPATITIS among Children below 10 Years: A Review

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

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