title: Hypoxic hepatitis in critically ill patients: incidence, etiology and risk factors for mortality.
abstract: OBJECTIVE
  Hypoxic hepatitis may be induced by hemodynamic instability or arterial hypoxemia in critically ill patients. We investigated the incidence, etiology, association with systemic ischemic injury and risk factors for mortality in this population.
  
  
  METHODS
  Retrospective analysis of patients with hypoxic hepatitis admitted to a multidisciplinary intensive care unit (ICU) of a university hospital. Hypoxic hepatitis was defined as the existence of a compatible clinical setting (cardiocirculatory failure or arterial hypoxemia) and aminotransferase levels higher than 1000 IU/L.
  
  
  RESULTS
  During the 8-year study period, 182 out of the 7674 patients admitted presented hypoxic hepatitis (2.4%). The most common cause was septic shock. The rate of in-hospital mortality in hypoxic hepatitis was 61.5% (112 patients), and was higher in patients with septic shock (83.3%) and cardiac arrest (77.7%). Ischemic pancreatitis (25.6%), rhabdomyolysis (41.2%) and renal failure (67.2%) were common in these patients. Risk factors of mortality were prolonged INR (p = 0.005), need for renal replacement therapy (p = 0.001) and septic shock (p = 0.005).
  
  
  CONCLUSIONS
  Hypoxic hepatitis was not a rare condition, and was frequently accompanied by multiorgan injury, with high mortality. Risk factors for increased mortality were prolonged INR, need for renal replacement therapy, and septic shock.
authors.affiliation: Servei de Medicina Intensiva, Hospital Universitari Son Dureta, c/ Andrea Doria 55, 07014 Palma de Mallorca, Illes Balears, Spain. joan.raurich@ssib.es
authors.forename: Joan M
authors.initials: JM
authors.lastname: Raurich
authors.forename: Juan Antonio
authors.initials: JA
authors.lastname: Llompart-Pou
authors.forename: Mireia
authors.initials: M
authors.lastname: Ferreruela
authors.forename: Asunción
authors.initials: A
authors.lastname: Colomar
authors.forename: Maria
authors.initials: M
authors.lastname: Molina
authors.forename: Cristina
authors.initials: C
authors.lastname: Royo
authors.forename: Ignacio
authors.initials: I
authors.lastname: Ayestarán
authors.forename: Jordi
authors.initials: J
authors.lastname: Ibáñez
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001784:Blood Gas Analysis; D016638:Critical Illness / Q000401:mortality*; D016208:Databases, Factual; D005260:Female; D006333:Heart Failure / Q000150:complications; D006439:Hemodynamics / Q000502:physiology; D006505:Hepatitis / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D000860:Hypoxia / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000150:complications; D012189:Retrospective Studies; D012206:Rhabdomyolysis / Q000150:complications; D012307:Risk Factors; D012769:Shock / Q000150:complications
chemical_list: D007770:L-Lactate Dehydrogenase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase