title: Hypoxic hepatopathy: pathophysiology and prognosis.
abstract: BACKGROUND
  Dramatic transient elevation in serum concentrations of hepatic enzymes occurs in some patients following a hypo-perfusion state. This entity is variously termed "shock liver" or "ischemic hepatitis", since the pathogenesis is considered to be ischemia. However, hypotension or shock is not always present.
  
  
  METHODS
  We analyzed the medical records of 293 patients (322 episodes) who had a hypoxic state and were admitted to the critical care units of two general hospitals over a 13-year period.
  
  
  RESULTS
  Hepatic injury was identified in about 1% of patients in critical care admissions. In addition to hypotension, the causes for hepatic injury were a low flow state secondary to congestive heart failure and hypoxia from sepsis or respiratory failure and hypoxemia from a variety of etiologies. These values were mostly normalized within several days when the hypoxic etiology was corrected and a serious co-morbid state did not intervene.
  
  
  CONCLUSIONS
  Marked elevation of hepatic enzymes can be identified not only in patients with hypotension, but also in normotensive patients in hypoxic state. Thus, the condition is appropriately termed hypoxic hepatopathy.
authors.affiliation: Medicine, St. Joseph's University Medical Center, USA. rbbirrer@yahoo.com
authors.forename: Richard
authors.initials: R
authors.lastname: Birrer
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Takuda
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Takara
mesh_terms: D000368:Aged; D015984:Causality; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006505:Hepatitis / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D006801:Humans; D007022:Hypotension / Q000453:epidemiology; D000860:Hypoxia / Q000453:epidemiology; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007511:Ischemia / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D007564:Japan / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009515:New Jersey / Q000453:epidemiology; D011379:Prognosis; D012131:Respiratory Insufficiency / Q000453:epidemiology; D012189:Retrospective Studies; D012769:Shock / Q000453:epidemiology; D016019:Survival Analysis; D014947:Wounds and Injuries / Q000453:epidemiology