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Impact of hypoxic hepatitis on mortality in the intensive care unit

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Abstract

Purpose

Hypoxic hepatitis (HH) is a form of hepatic injury following arterial hypoxemia, ischemia, and passive congestion of the liver. We investigated the incidence and the prognostic implications of HH in the medical intensive care unit (ICU).

Methods

A total of 1,066 consecutive ICU admissions at three medical ICUs of a university hospital were included in this prospective cohort study. All patients were screened prospectively for the presence of HH according to established criteria. Independent risk factors of mortality in this cohort of critically ill patients were identified by a multivariate Poisson regression model.

Results

A total of 118 admissions (11%) had HH during their ICU stay. These patients had different baseline characteristics, longer median ICU stay (8 vs. 6 days, p < 0.001), and decreased ICU survival (43 vs. 83%, p < 0.001). The crude mortality rate ratio of admissions with HH was 4.62 (95% CI 3.63–5.86, p < 0.001). Regression analysis demonstrated strong mortality risk for admissions with HH requiring vasopressor therapy (adjusted rate ratio 4.91; 95% CI 2.51–9.60, p < 0.001), whereas HH was not significantly associated with mortality in admissions without vasopressor therapy (adjusted rate ratio 1.79, 95% CI 0.52–6.23, p = 0.359).

Conclusions

Hypoxic hepatitis (HH) occurs frequently in the medical ICU. The presence of HH is a strong risk factor for mortality in the ICU in patients requiring vasopressor therapy.

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Abbreviations

ALT:

Serum alanine transaminase

AST:

Serum aspartate transaminase

CI:

Confidence interval

ICU:

Intensive care unit

IQR:

Interquartile range

HH:

Hypoxic hepatitis

RR:

Rate ratio

SAPS:

Simplified acute physiology score

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Conflict of interest

The authors of have nothing to disclose.

Author information

Authors and Affiliations

  1. Intensive Care Unit 13H1, Department of Gastroenterology and Hepatology, Internal Medicine 3, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria

    Valentin Fuhrmann, Nikolaus Kneidinger, Christian Madl & Peter Schenk

  2. Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria

    Harald Herkner

  3. Intensive Care Unit 13H3, Department of Cardiology, Internal Medicine 2, Medical University of Vienna, Vienna, Austria

    Gottfried Heinz & Mariam Nikfardjam

  4. Intensive Care Unit 13I2, Internal Medicine 1, Medical University of Vienna, Vienna, Austria

    Anja Bojic & Peter Schellongowski

  5. Department of Gastroenterology and Hepatology, Internal Medicine 3, Medical University of Vienna, Vienna, Austria

    Bernhard Angermayr & Maximilian Schöniger-Hekele

Authors
  1. Valentin Fuhrmann
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  2. Nikolaus Kneidinger
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  3. Harald Herkner
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  4. Gottfried Heinz
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  5. Mariam Nikfardjam
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  6. Anja Bojic
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  7. Peter Schellongowski
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  8. Bernhard Angermayr
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  9. Maximilian Schöniger-Hekele
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  10. Christian Madl
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  11. Peter Schenk
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Corresponding author

Correspondence to Valentin Fuhrmann.

Additional information

The study was performed at the intensive care units 13H1, 13H3, and 13I2 of the Medical University of Vienna.

Appendix

Appendix

See Fig. 1 and Table 5

Fig. 1
figure a

Cumulative survival rate of 118 admissions with hypoxic hepatitis and 948 admissions without hypoxic hepatitis. Survival was significantly higher in patients without hypoxic hepatitis (log rank test)

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Table 5 Main underlying admission diagnosis stratified according to the presence or absence of vasopressor therapy
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Fuhrmann, V., Kneidinger, N., Herkner, H. et al. Impact of hypoxic hepatitis on mortality in the intensive care unit. Intensive Care Med 37, 1302–1310 (2011). https://doi.org/10.1007/s00134-011-2248-7

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  • DOI: https://doi.org/10.1007/s00134-011-2248-7

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