Elliot B Tapper1, Neil Sengupta2, Alan Bonder2. 1. Division of Gastroenterology/Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass. Electronic address: etapper@bidmc.harvard.edu. 2. Division of Gastroenterology/Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.
Abstract
BACKGROUND: Ischemic hepatitis is a devastating cause of acute liver injury. Data are limited regarding its incidence and outcomes. METHODS: Systematic review and meta-analysis of studies from PubMed, EMBASE, and Web of Science with specific search terms. Inclusion criteria included case series with >10 patients and clear case definition (especially liver enzyme levels >10 times the upper limit of normal). RESULTS: Twenty-four papers met inclusion criteria. A total of 1782 cases were identified in these papers (mean 78 per paper, range 12-322). The pooled average age of the included patients was 64.2 years, and their mean peak aspartate aminotransferase level, alanine aminotransferase level, and total bilirubin were 2423 IU/L, 1893 IU/L, and 2.55 mg/dL, respectively. Ischemic hepatitis was present in 2 of every 1000 admissions; including 2.5 of every 100 intensive care unit admissions and 4 of 10 admissions associated with an aminotransferase level >10 times the upper limit of normal. The pooled proportions of patients with ischemic hepatitis who had a predisposing acute cardiac event or sepsis were 78.2% and 23.4%, respectively. The proportion of patients with a documented hypotensive event of any duration was 52.9%. Overall, the pooled rate of survival to discharge was 51% (range 23.1%-85.7%). CONCLUSIONS: Ischemic hepatitis is a common cause of severe acute liver injury and is associated with a significant risk of in-hospital death. A major opportunity in the management of ischemic hepatitis is recognition of the condition without documented hypotension.
BACKGROUND:Ischemic hepatitis is a devastating cause of acute liver injury. Data are limited regarding its incidence and outcomes. METHODS: Systematic review and meta-analysis of studies from PubMed, EMBASE, and Web of Science with specific search terms. Inclusion criteria included case series with >10 patients and clear case definition (especially liver enzyme levels >10 times the upper limit of normal). RESULTS: Twenty-four papers met inclusion criteria. A total of 1782 cases were identified in these papers (mean 78 per paper, range 12-322). The pooled average age of the included patients was 64.2 years, and their mean peak aspartate aminotransferase level, alanine aminotransferase level, and total bilirubin were 2423 IU/L, 1893 IU/L, and 2.55 mg/dL, respectively. Ischemic hepatitis was present in 2 of every 1000 admissions; including 2.5 of every 100 intensive care unit admissions and 4 of 10 admissions associated with an aminotransferase level >10 times the upper limit of normal. The pooled proportions of patients with ischemic hepatitis who had a predisposing acute cardiac event or sepsis were 78.2% and 23.4%, respectively. The proportion of patients with a documented hypotensive event of any duration was 52.9%. Overall, the pooled rate of survival to discharge was 51% (range 23.1%-85.7%). CONCLUSIONS:Ischemic hepatitis is a common cause of severe acute liver injury and is associated with a significant risk of in-hospital death. A major opportunity in the management of ischemic hepatitis is recognition of the condition without documented hypotension.
Authors: Felicity Lee; Jordan H Hutson; Munir Boodhwani; Bernard McDonald; Derek So; Sophie De Roock; Fraser Rubens; Ellamae Stadnick; Marc Ruel; Michel Le May; Marino Labinaz; Kevin Chien; Habibat A Garuba; Lisa M Mielniczuk; Sharon Chih Journal: CJC Open Date: 2020-03-27
Authors: Astrid Van den Broecke; Laura Van Coile; Alexander Decruyenaere; Kirsten Colpaert; Dominique Benoit; Hans Van Vlierberghe; Johan Decruyenaere Journal: Ann Intensive Care Date: 2018-01-30 Impact factor: 6.925