Intensive Care Unit 13H1, Department of Gastroenterology and Hepatology, Internal Medicine 3, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
Intensive Care Med. 2011 Aug;37(8):1302-10. doi: 10.1007/s00134-011-2248-7. Epub 2011 Jun 7.
Hypoxic hepatitis (HH) is a form of hepatic injury following arterial hypoxemia, ischemia, and passive congestion of the liver. We investigated the incidence and the prognostic implications of HH in the medical intensive care unit (ICU).
A total of 1,066 consecutive ICU admissions at three medical ICUs of a university hospital were included in this prospective cohort study. All patients were screened prospectively for the presence of HH according to established criteria. Independent risk factors of mortality in this cohort of critically ill patients were identified by a multivariate Poisson regression model.
A total of 118 admissions (11%) had HH during their ICU stay. These patients had different baseline characteristics, longer median ICU stay (8 vs. 6 days, p < 0.001), and decreased ICU survival (43 vs. 83%, p < 0.001). The crude mortality rate ratio of admissions with HH was 4.62 (95% CI 3.63-5.86, p < 0.001). Regression analysis demonstrated strong mortality risk for admissions with HH requiring vasopressor therapy (adjusted rate ratio 4.91; 95% CI 2.51-9.60, p < 0.001), whereas HH was not significantly associated with mortality in admissions without vasopressor therapy (adjusted rate ratio 1.79, 95% CI 0.52-6.23, p = 0.359).
Hypoxic hepatitis (HH) occurs frequently in the medical ICU. The presence of HH is a strong risk factor for mortality in the ICU in patients requiring vasopressor therapy.
低氧性肝炎（HH）是一种肝损伤，发生于动脉低氧血症、缺血和肝脏被动充血之后。我们研究了 HH 在医学重症监护病房（ICU）中的发生率及其对预后的影响。
这项前瞻性队列研究纳入了一家大学医院的三个医学 ICU 中连续的 1066 例 ICU 入住患者。所有患者均根据既定标准前瞻性筛查 HH 的存在。通过多变量泊松回归模型确定该危重症患者队列中死亡的独立危险因素。
共有 118 例（11%）入住 ICU 期间发生 HH。这些患者具有不同的基线特征，ICU 中位住院时间更长（8 天 vs. 6 天，p < 0.001），ICU 生存率降低（43% vs. 83%，p < 0.001）。HH 患者的粗死亡率比值为 4.62（95% CI 3.63-5.86，p < 0.001）。回归分析表明，HH 患者需要血管加压素治疗的死亡率风险较高（调整后的比率比 4.91；95% CI 2.51-9.60，p < 0.001），而 HH 与不需要血管加压素治疗的患者的死亡率无显著相关性（调整后的比率比 1.79，95% CI 0.52-6.23，p = 0.359）。
HH 在医学 ICU 中较为常见。在需要血管加压素治疗的患者中，HH 的存在是 ICU 死亡率的一个重要危险因素。
