title: The Incidence and Outcomes of Ischemic Hepatitis: A Systematic Review with Meta-analysis.
abstract: BACKGROUND
  Ischemic hepatitis is a devastating cause of acute liver injury. Data are limited regarding its incidence and outcomes.
  
  
  METHODS
  Systematic review and meta-analysis of studies from PubMed, EMBASE, and Web of Science with specific search terms. Inclusion criteria included case series with >10 patients and clear case definition (especially liver enzyme levels >10 times the upper limit of normal).
  
  
  RESULTS
  Twenty-four papers met inclusion criteria. A total of 1782 cases were identified in these papers (mean 78 per paper, range 12-322). The pooled average age of the included patients was 64.2 years, and their mean peak aspartate aminotransferase level, alanine aminotransferase level, and total bilirubin were 2423 IU/L, 1893 IU/L, and 2.55 mg/dL, respectively. Ischemic hepatitis was present in 2 of every 1000 admissions; including 2.5 of every 100 intensive care unit admissions and 4 of 10 admissions associated with an aminotransferase level >10 times the upper limit of normal. The pooled proportions of patients with ischemic hepatitis who had a predisposing acute cardiac event or sepsis were 78.2% and 23.4%, respectively. The proportion of patients with a documented hypotensive event of any duration was 52.9%. Overall, the pooled rate of survival to discharge was 51% (range 23.1%-85.7%).
  
  
  CONCLUSIONS
  Ischemic hepatitis is a common cause of severe acute liver injury and is associated with a significant risk of in-hospital death. A major opportunity in the management of ischemic hepatitis is recognition of the condition without documented hypotension.
authors: Division of Gastroenterology/Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass. Electronic address: etapper@bidmc.harvard.edu.
authors: Elliot B
authors: EB
authors: Tapper
authors: Division of Gastroenterology/Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.
authors: Neil
authors: N
authors: Sengupta
authors: Division of Gastroenterology/Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass.
authors: Alan
authors: A
authors: Bonder
mesh_terms: D006505:Hepatitis / Q000150:complications / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D015994:Incidence; D007511:Ischemia / Q000150:complications* / Q000175:diagnosis; D008099:Liver / Q000098:blood supply*
keywords: Congestive heart failure; Congestive hepatopathy; Hypoxic hepatitis; Liver failure; Shock liver