Liver Histology in Septic Patients: Is It All About Ductular Cholestasis?

Abstract

Context.— Cholestasis within bile ductules is touted as a key histologic finding in septic patients but is not entirely sensitive or specific. The spectrum of other histopathologic findings in septic patients has not been thoroughly studied. Objective.— To evaluate histologic features in liver biopsies from septic patients, as well as mimics. Design.— For 121 liver samples where sepsis was mentioned in provided clinical information or in the pathologic differential diagnosis, we compiled patient outcome, clinical impression (sepsis or not), and blood culture results. We evaluated each case for inflammatory and cholestatic histologic findings, comparing them between patients with and without clinical sepsis, and between patients with gram-positive versus gram-negative results on blood culture. Results.— Cases from clinically septic patients (n = 77) showed portal mononuclear inflammation (52 cases, 68%), lobular neutrophilic inflammation (45, 58%), ductular reaction (58, 75%), lobular cholestasis (68, 88%), ductular cholestasis (52, 68%), and acidophil bodies (36, 47%). Findings between clinically septic and nonseptic patients were similar, though the latter more often had lobular mononuclear inflammation (19% versus 45%, P = .004). Ductular cholestasis rates were similar in both groups (68% versus 55%, P = .17). Ductular cholestasis had a sensitivity of 68%, a specificity of 45%, a positive predictive value of 68%, and an accuracy of 60% for the diagnosis of sepsis. Gram-positive and gram-negative sepsis caused comparable findings. Conclusions.— Ductular cholestasis can be present in septic and nonseptic liver samples, though its presence does suggest the possibility of sepsis. Other common findings in sepsis include lobular cholestasis, ductular reaction, portal mononuclear inflammation, and lobular neutrophilic inflammation.

Editorial: How often can we get the right diagnosis after bone marrow transplant in patients with abnormal liver function tests?

“…4 Sepsis-associated liver injury (SALI) is also frequent and multifactorial. 5 Less often, relapse of haematological disease, cholelithiasis, viral reactivation (hepatitis B virus and cytomegalovirus), hepatitis E, 6 ischaemic hepatitis, iron overload (secondary in part to transfusions) 7 and metabolic dysfunction-associated steatotic liver disease can also be the culprit. 8 More than 50% of the patients have liver function test (LFT) abnormalities and 25% have an increase of bilirubin after BMT.…”

“…They can be related to immunosuppressive conditioning therapy ( e.g ., busulfan, cyclophosphamide, gemtuzumab ozogamicin, inotuzumab ozogamicin and total body irradiation), to the transplantation itself such as graft versus host disease (GVHD) 2 or sinusoidal obstruction syndrome (SOS), 3 to drug‐induced liver injury (DILI) after transplantation ( e.g ., antifungals) 4 . Sepsis‐associated liver injury (SALI) is also frequent and multifactorial 5 . Less often, relapse of haematological disease, cholelithiasis, viral reactivation (hepatitis B virus and cytomegalovirus), hepatitis E, 6 ischaemic hepatitis, iron overload (secondary in part to transfusions) 7 and metabolic dysfunction‐associated steatotic liver disease can also be the culprit 8 .…”