Hypoxic hepatitis is an acute liver injury often referred to as ‘ischemic hepatitis’ or ‘shock liver’, which is more frequently observed in intensive care units. Cardiac failure, respiratory failure, and toxic-septic shock are the main underlying conditions leading to a rate of in-hospital mortality of greater than 50%. Rapid identification is important; any delay in diagnosis of hypoxic hepatitis can deteriorate the condition. The only standard management is to correct the predisposing condition and the newest therapies require additional research analysis before they can be widely recommended.
What is The Prognosis for Shock Liver?
The prognosis is generally poor in the life-threatening conditions underlying hypoxic hepatitis. The rates of in-hospital mortality from two scientific publication reviews were 56% and 59%. Another report says 1-year survival at near 25%.
The cause of death in hypoxic hepatitis is usually not liver failure, but the predisposing condition. In a study of a large European cohort, the risk of in-hospital mortality was found to be significantly greater among patients with higher peak levels of aspartate aminotransferase, lactate dehydrogenase, international normalized ratio, and lactate.
In addition, prolonged duration of hypoxic hepatitis (defined as >24 hours of rising aspartate aminotransferase levels) were found to be associated with significantly poorer overall survival.
Other biochemical and clinical abnormalities are associated with increased risk of in-hospital mortality as well, including increased phosphate levels, encephalopathy, jaundice, and, in a recent prospective study, ICG plasma disappearance rate. The long-term outcome, however, is still largely determined by the overall cardiovascular morbidity and mortality.
At liver level, the therapeutic goals are to increase oxygen delivery and to ease oxygen exchanges between blood and liver cells. The absence of appropriate treatment causes the prognosis is poor. Briefly, restoring systemic hemodynamics remains the main target by optimizing arterial oxygen content, achieving adequate vascular filling, boosting cardiac output and restoring arterial pressure.
The prognosis is poor with half of the patients death occurs within a few days or weeks and fatality is mainly related to the severity of underlying conditions. Currently, there exists no specific treatment for this liver injury. The prompt identification and management of underlying conditions are crucial to the prognosis.