Hypoxic Hepatitis: Prevalence, Biochemical Markers, and Risk Factor of Mortality in a Large Tertiary Hospital
Wutthiphat Amornmongkhol¹, Tawesak Tanwandee²
Affiliation : ¹ Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, ² Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background: Hypoxic hepatitis (HH) is an acute severe liver injury usually associated with several types of hemodynamic instability. The mortality rate is about 50% to 70%.
Objective: To evaluate the prevalence of HH and to study the clinical course and outcomes of these patients.
Materials and Methods: The present study was a retrospective study conducted at Siriraj Hospital. Data were retrieved from the hospital admissions between 2008 and 2018. HH was defined by serum aspartate aminotransferase (AST) or alanine aminotransferase (ALT) levels of more than or equal to 20 times the upper limit of normal in the absence of other causes. Baseline patients’ condition, laboratory, and clinical course were collected.
Results: Of the 4,000 admissions, 29 (0.73%) met the criteria for HH. Mean age was 68.2 years old and the median serum AST and ALT levels at the time of diagnosis were 2,065 and 815 IU/L, respectively. Underlying diseases in these patients included hypertension (69%), diabetes mellitus (48.3%), and chronic kidney disease (37.9%). Comorbidities included acute kidney injury (93.1%), sepsis (79.3%), hypotension (75.9%), requirement of vasopressors (65.5%), and acute respiratory failure (55.2%). The mortality rate at day 28 was 72.4%, none were liver related. The only significant risk factor for mortality was lower bicarbonate levels at the time of diagnosis (p=0.012).
Conclusion: HH is uncommon, at 0.73%, and most patients had episodes of hypotension and multi-organ failure. Monitoring of liver function test is advised in this group of patients. The twenty-eight-day mortality rate was 72.4% but none from liver failure. The most common cause of mortality was related to comorbidity of the patients and the only predictor of high mortality was the lower bicarbonate level.
Received 1 March 2022 | Revised 4 April 2022 | Accepted 20 April 2022
DOI: 10.35755/jmedassocthai.2022.06.13329
Keywords : Hypoxic hepatitis; Ischemic hepatitis; Shock liver; Mortality; Multi-organ failure
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