title: Hypoxic hepatitis occurring in cirrhosis after variceal bleeding: still a lethal disease.
abstract: BACKGROUND
  Hypoxic hepatitis (HH) occurring after gastrointestinal bleeding in cirrhotic patients has been scarcely studied and is reported as a rare occurrence carrying a severe prognosis. The management of bleeding from esophageal varices (BEV) and similarly the prognosis has improved in the last decades.
  
  
  OBJECTIVE
  To evaluate retrospectively the incidence, clinical features, risk factors, and outcome of HH occurring in cirrhotic patients with BEV treated with the current standard therapy. Cirrhotics with BEV consecutively admitted from 2004 to 2008 were considered. Standard therapy consisted of intensive care support, somatostatin, antibiotics, and band ligation. HH was diagnosed if an elevation of alanine aminotransferase >10-fold from basal occurred.
  
  
  RESULTS
  Among 349 patients admitted for BEV, 24 (6.8%) had HH. Most patients were over 60 years old and had advanced liver disease; 41.7% had hepatocellular carcinoma, and 29.2% had portal vein thrombosis (PVT). Hypovolemic shock occurred in 16 (66.7%) patients, and failure to control initial bleeding in 12 (50%) patients. The 6-week mortality rate was 83.3% in HH compared with 24.6% in non-HH patients. Causes of death were massive bleeding in 4, hepatic encephalopathy in 7, and renal failure in 9. Binary logistic regression analysis showed that failure to control initial bleeding, diabetes, and PVT were factors independently associated with the development of HH.
  
  
  CONCLUSIONS
  HH occurring in cirrhosis with gastrointestinal bleeding still carries an ominous prognosis. The severity of hemorrhage as expressed by failure to control bleeding contributes heavily to HH; in addition, the presence of PVT and diabetes further compromising the hepatic circulatory reserve may favor hypoxic damage.
authors: Gastroenterology Unit, AORN A Cardarelli, Naples, Italy. luamitra@tin.it
authors: Lucio
authors: L
authors: Amitrano
authors: Maria Anna
authors: MA
authors: Guardascione
authors: Rossana
authors: R
authors: Martino
authors: Francesco
authors: F
authors: Manguso
authors: Antonella
authors: A
authors: Menchise
authors: Antonio
authors: A
authors: Balzano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis; D004932:Esophageal and Gastric Varices / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D006505:Hepatitis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000150:complications* / Q000209:etiology; D008113:Liver Neoplasms / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors