Ischaemic hepatitis in an Intensive Care unit

Abstract

Background

Ischaemic Hepatitis is a clinicai syndrome seen in Intensive Care Unit patients, associated with severe hypotension and/or hypoxia. It is defined as an increase, in the first 12-24 hours, in serum aminotransferase activity, at least 10 times above the upper limit of normal, followed by resolution to near normal leveis within the first 10 days.

Materiais and Methods

The authors studied retrospectively, the prevalence and clinical features of this entity, assessing its influence on patient outcome, in a level III lntensive Care Unit.

ln the 5 days prior to the peak elevation of aminotransferase activity, the following parameters were studied: - Haemoglobin, lactic acid, pH and paO₂.

The maximum leveis and day of resolution were assessed for the following items: Alanine amino­ transferase (ALT), aspartate aminotransferase (AST), lactic dehydrogenase (LDH), bilirubin, prothrombin ratio and creatinine.

Results and Conclusions

Over a period of 5 years and 3 months, 40 patients with ischaemic hepatitis were identified - prevalence 2,8% - 23 males, 17 females, and mean age 64,9 years.

Ischaemic Hepatitis was associated with high values of both illness severity scoring systems (APACHE II and SAPS I) and therapeutic in­ tervention scoring system (TISS). Both decreased perfusion and hypoxia caused a rapid elevation of aminotransferases and lactic dehydrogenase; the former correlated with a reduced prothrombin ratio.

Prothrombin ratio was the only parameter which correlated with mortality.