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Hypoxic hepatitis – epidemiology, pathophysiology and clinical management

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Zusammenfassung

Hypoxische Hepatitis (HH) – auch unter den Bezeichnungen ichämische Hepatitis oder Schockleber bekannt – ist durch eine zentrilobuläre Leberzellnekrose und einen fulminanten Anstieg der Serumaminotransferasen als Folge von kardialem, zirkulatorischem oder respiratorischem Versagen charakterisiert. Dies ist die häufigste Ursache der akuten Leberschädigung mit einer Prävalenz von bis zu 10 Prozent an Intensivstationen. Kritisch kranke Patienten mit HH und der Notwendigkeit einer Vasopressorentherapie haben ein signifikant erhöhtes Mortalitätsrisiko. Die häufigsten HH auslösenden Ursachen sind erniedrigtes Herzauswurfvolumen und septischer Schock, wobei in der großen Mehrheit der Fälle eine multifaktorielle Ätiologie der HH zugrunde liegt. HH kann verschiedene Komplikationen wie spontane Hypoglykämie, respiratorische Insuffizienz als Folge des hepatopulmonalen Syndroms und Hyperammoniämie verursachen. HH bildet sich nach erfolgreicher Behandlung der zugrunde liegenden Ursachen zurück. Derzeit sind keine Therapieansätze etabliert, die spezifisch die Leberfunktion verbessern. Ein frühestmögliches Erkennen der HH, ihrer zugrunde liegenden Ursachen sowie die unverzügliche Einleitung entsprechender Therapiemaßnahmen sind von zentraler prognostischer Bedeutung. Diese Übersichtsarbeit vermittelt den heutigen Wissensstand hinsichtlich Epidemiologie, Pathophysiologie, sowie diagnostischen und therapeutischen Möglichkeiten der HH.

Summary

Hypoxic hepatitis (HH), also known as ischemic hepatitis or shock liver, is characterized by centrilobular liver cell necrosis and sharply increasing serum aminotransferase levels in a clinical setting of cardiac, circulatory or respiratory failure. Nowadays it is recognized as the most frequent cause of acute liver injury with a reported prevalence of up to 10% in the intensive care unit. Patients with HH and vasopressor therapy have a significantly increased mortality risk in the medical intensive care unit population. The main underlying conditions contributing to HH are low cardiac output and septic shock, although a multifactorial etiology is found in the majority of patients. HH causes several complications such as spontaneous hypoglycemia, respiratory insufficiency due to the hepatopulmonary syndrome, and hyperammonemia. HH reverses after successful treatment of the basic HH-causing disease. No specific therapies improving the hepatic function in patients with HH are currently established. Early recognition of HH and its underlying diseases and subsequent initiation of therapy is of central prognostic importance. The purpose of this review is to provide an update on the epidemiology, pathophysiology, and diagnostic and therapeutic options of HH.

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  1. Department of Internal Medicine 3, Division of Gastroenterology and Hepatology, Intensive Care Unit 13H1, Medical University Vienna, Vienna, Austria

    Valentin Fuhrmann, Bernhard Jäger & Andreas Drolz

  2. Department of Surgery, Klinikum Ansbach, Germany

    Anna Zubkova

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  1. Valentin Fuhrmann
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Correspondence to Valentin Fuhrmann.

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Fuhrmann, V., Jäger, B., Zubkova, A. et al. Hypoxic hepatitis – epidemiology, pathophysiology and clinical management. Wien Klin Wochenschr 122, 129–139 (2010). https://doi.org/10.1007/s00508-010-1357-6

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