Servei de Medicina Intensiva, Hospital Universitari Son Dureta, c/ Andrea Doria 55, 07014 Palma de Mallorca, Illes Balears, Spain.
J Anesth. 2011 Feb;25(1):50-6. doi: 10.1007/s00540-010-1058-3. Epub 2010 Dec 9.
Hypoxic hepatitis may be induced by hemodynamic instability or arterial hypoxemia in critically ill patients. We investigated the incidence, etiology, association with systemic ischemic injury and risk factors for mortality in this population.
Retrospective analysis of patients with hypoxic hepatitis admitted to a multidisciplinary intensive care unit (ICU) of a university hospital. Hypoxic hepatitis was defined as the existence of a compatible clinical setting (cardiocirculatory failure or arterial hypoxemia) and aminotransferase levels higher than 1000 IU/L.
During the 8-year study period, 182 out of the 7674 patients admitted presented hypoxic hepatitis (2.4%). The most common cause was septic shock. The rate of in-hospital mortality in hypoxic hepatitis was 61.5% (112 patients), and was higher in patients with septic shock (83.3%) and cardiac arrest (77.7%). Ischemic pancreatitis (25.6%), rhabdomyolysis (41.2%) and renal failure (67.2%) were common in these patients. Risk factors of mortality were prolonged INR (p = 0.005), need for renal replacement therapy (p = 0.001) and septic shock (p = 0.005).
Hypoxic hepatitis was not a rare condition, and was frequently accompanied by multiorgan injury, with high mortality. Risk factors for increased mortality were prolonged INR, need for renal replacement therapy, and septic shock.
在危重病患者中，血流动力学不稳定或动脉低氧血症可能导致缺氧性肝炎。我们研究了该人群中缺氧性肝炎的发生率、病因、与全身缺血性损伤的关系以及死亡的危险因素。
回顾性分析了一所大学医院多学科重症监护病房（ICU）收治的缺氧性肝炎患者。缺氧性肝炎的定义为存在符合临床情况（心循环衰竭或动脉低氧血症）和转氨酶水平高于 1000IU/L。
在 8 年的研究期间，7674 名入院患者中有 182 名出现缺氧性肝炎（2.4%）。最常见的病因是感染性休克。缺氧性肝炎患者的住院死亡率为 61.5%（112 例），感染性休克（83.3%）和心搏骤停（77.7%）患者的死亡率更高。这些患者中常见的缺血性胰腺炎（25.6%）、横纹肌溶解症（41.2%）和肾衰竭（67.2%）。
死亡的危险因素是延长的 INR（p=0.005）、需要肾脏替代治疗（p=0.001）和感染性休克（p=0.005）。
缺氧性肝炎并不罕见，常伴有多器官损伤，死亡率高。增加死亡率的危险因素是延长的 INR、需要肾脏替代治疗和感染性休克。
