Compensated Cardiogenic Shock: A Subset with Damage Limited to Liver and Kidneys

“…That being said, an ideal inotropic agent has not yet been identified, and the existing studies have reported only limited benefit in specific clinical circumstances. For example, dopamine may offer a survival benefit for patients with normotensive cardiogenic shock and kidney injury, 54 and dobutamine has been proposed to augment splanchnic blood flow to the liver in patients with low cardiac index. 55 The findings from these small studies are not widely generalizable, however.…”

Section: Managementmentioning

confidence: 99%

Hypoxic Hepatitis: A Review and Clinical Update

2016

JCTH

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Hypoxic hepatitis (HH), also known as ischemic hepatitis or shock liver, is characterized by a massive, rapid rise in serum aminotransferases resulting from reduced oxygen delivery to the liver. The most common predisposing condition is cardiac failure, followed by circulatory failure as occurs in septic shock and respiratory failure. HH does, however, occur in the absence of a documented hypotensive event or shock state in 50% of patients. In intensive care units, the incidence of HH is near 2.5%, but has been reported as high as 10% in some studies. The pathophysiology is multifactorial, but often involves hepatic congestion from right heart failure along with reduced hepatic blood flow, total body hypoxemia, reduced oxygen uptake by hepatocytes or reperfusion injury following ischemia. The diagnosis is primarily clinical, and typically does not require liver biopsy. The definitive treatment of HH involves correction of the underlying disease state, but successful management includes monitoring for the potential complications such as hypoglycemia, hyperglycemia, hyperammonemia and hepatopulmonary syndrome. Prognosis of HH remains poor, especially for cases in which there was a delay in diagnosis. The in-hospital mortality rate is >50%, and the most frequent cause of death is the predisposing condition and not the liver injury itself.

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“…Naschitz et al reported improvement of outcome in patients with nonhypotensive cardiogenic shock accompanied by renal and hepatic injury after administration of dopamine [89][90][91]. Others observed in a small retrospective study that patients (n = 28) receiving calcium-channel blockers and/or antiarrhythmic drugs had a higher mortality risk [92] and suggested that this may be a consequence of decreased clearance of hepatic drugs and altered cardiac sensitivity.…”

Section: The Liver As a Therapeutic Targetmentioning

confidence: 99%

Hypoxic hepatitis – epidemiology, pathophysiology and clinical management

Fuhrmann

Jäger

Zubkova³

et al. 2010

Wien Klin Wochenschr

114

112

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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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Compensated Cardiogenic Shock: A Subset with Damage Limited to Liver and Kidneys

Cited by 13 publications

References 12 publications

Impact of hypoxic hepatitis on mortality in the intensive care unit

Impact of hypoxic hepatitis on mortality in the intensive care unit

Hypoxic Hepatitis: A Review and Clinical Update

Hypoxic hepatitis – epidemiology, pathophysiology and clinical management

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