Department of General-, Visceral- and Transplant Surgery, University Hospital Essen, Germany.
Eur J Med Res. 2009;14(12):541-6. doi: 10.1186/2047-783x-14-12-541.
Congestive heart failure as a cause of acute liver failure is rarely documented with only a few cases. Although the pathophysiology is poorly understood, there is rising evidence, that low cardiac output with consecutive reduction in hepatic blood flow is a main causing factor, rather than hypotension. In the setting of acute liver failure due to congestive heart failure, clinical signs of the latter can be absent, which requires an appropriate diagnostic approach. As a reference center for acute liver failure and liver transplantation we recorded from May 2003 to December 2007 202 admissions with the primary diagnoses acute liver failure. 13/202 was due to congestive heart failure, which was associated with a mortality rate of 54%. Leading cause of death was the underlying heart failure. Asparagine transaminase (AST), bilirubin, and international normalized ratio (INR) did not differ significantly in surviving and deceased patients at admission. Despite both groups had signs of cardiogenic shock, the cardiac index (CI) was significantly higher in the survival group on admission as compared with non-survivors (2.1 L/min/m(2) vs. 1.6 L/min/m(2), p=0.04). Central venous - and pulmonary wedge pressure did not differ significantly. Remarkable improvement of liver function was recorded in the group, who recovered from cardiogenic shock. In conclusion, patients with acute liver failure require an appropriate diagnostic approach. Congestive heart failure should always be considered as a possible cause of acute liver failure.
充血性心力衰竭作为急性肝功能衰竭的一个原因很少被记录，仅有少数病例。尽管病理生理学尚不清楚，但越来越多的证据表明，低心输出量导致肝血流量减少是主要原因，而不是低血压。在由充血性心力衰竭引起的急性肝功能衰竭中，后者的临床体征可能不存在，这需要适当的诊断方法。作为急性肝功能衰竭和肝移植的参考中心，我们记录了 2003 年 5 月至 2007 年 12 月期间 202 例以急性肝功能衰竭为主要诊断的入院病例。13/202 例是由于充血性心力衰竭，其死亡率为 54%。导致死亡的主要原因是潜在的心力衰竭。入院时存活和死亡患者的天冬氨酸转氨酶（AST）、胆红素和国际标准化比值（INR）无显著差异。尽管两组均有心力衰竭的迹象，但存活组入院时的心指数（CI）明显高于非存活组（2.1 L/min/m2 与 1.6 L/min/m2，p=0.04）。中心静脉压和肺楔压无显著差异。从心源性休克中恢复的患者记录了肝功能的显著改善。总之，急性肝功能衰竭患者需要适当的诊断方法。充血性心力衰竭应始终被视为急性肝功能衰竭的一个可能原因。
