Critical care hepatology: definitions, incidence, prognosis and role of liver failure in critically ill patients
Abstract Organ dysfunction or overt failure is a commonplace event in the critically ill affecting up to 70% of patients during their stay in the ICU. The outcome depends on the resolution of impaired organ function, while a domino-like deterioration of organs other than the primarily affected ones...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2022-09-01
|
| Series: | Critical Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13054-022-04163-1 |
| _version_ | 1811236510060511232 |
|---|---|
| author | Aritz Perez Ruiz de Garibay Andreas Kortgen Julia Leonhardt Alexander Zipprich Michael Bauer |
| author_facet | Aritz Perez Ruiz de Garibay Andreas Kortgen Julia Leonhardt Alexander Zipprich Michael Bauer |
| author_sort | Aritz Perez Ruiz de Garibay |
| collection | DOAJ |
| description | Abstract Organ dysfunction or overt failure is a commonplace event in the critically ill affecting up to 70% of patients during their stay in the ICU. The outcome depends on the resolution of impaired organ function, while a domino-like deterioration of organs other than the primarily affected ones paves the way for increased mortality. “Acute Liver Failure” was defined in the 1970s as a rare and potentially reversible severe liver injury in the absence of prior liver disease with hepatic encephalopathy occurring within 8 weeks. Dysfunction of the liver in general reflects a critical event in “Multiple Organ Dysfunction Syndrome” due to immunologic, regulatory and metabolic functions of liver parenchymal and non-parenchymal cells. Dysregulation of the inflammatory response, persistent microcirculatory (hypoxic) impairment or drug-induced liver injury are leading problems that result in “secondary liver failure,” i.e., acquired liver injury without underlying liver disease or deterioration of preexisting (chronic) liver disease (“Acute-on-Chronic Liver Failure”). Conventional laboratory markers, such as transaminases or bilirubin, are limited to provide insight into the complex facets of metabolic and immunologic liver dysfunction. Furthermore, inhomogeneous definitions of these entities lead to widely ranging estimates of incidence. In the present work, we review the different definitions to improve the understanding of liver dysfunction as a perpetrator (and therapeutic target) of multiple organ dysfunction syndrome in critical care. Graphic Abstract |
| first_indexed | 2024-04-12T12:09:40Z |
| format | Article |
| id | doaj.art-e79362fc088e4f93843aeb413b7b615b |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-04-12T12:09:40Z |
| publishDate | 2022-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-e79362fc088e4f93843aeb413b7b615b2022-12-22T03:33:37ZengBMCCritical Care1364-85352022-09-0126111610.1186/s13054-022-04163-1Critical care hepatology: definitions, incidence, prognosis and role of liver failure in critically ill patientsAritz Perez Ruiz de Garibay0Andreas Kortgen1Julia Leonhardt2Alexander Zipprich3Michael Bauer4University of Strasbourg, CNRS, Immunopathology and Therapeutic Chemistry, UPR 3572Department of Anesthesiology and Intensive Care Medicine, Jena University HospitalDepartment of Anesthesiology and Intensive Care Medicine, Jena University HospitalDepartment of Internal Medicine IV (Gastroenterology, Hepatology, Infectious Diseases), Jena University HospitalDepartment of Anesthesiology and Intensive Care Medicine, Jena University HospitalAbstract Organ dysfunction or overt failure is a commonplace event in the critically ill affecting up to 70% of patients during their stay in the ICU. The outcome depends on the resolution of impaired organ function, while a domino-like deterioration of organs other than the primarily affected ones paves the way for increased mortality. “Acute Liver Failure” was defined in the 1970s as a rare and potentially reversible severe liver injury in the absence of prior liver disease with hepatic encephalopathy occurring within 8 weeks. Dysfunction of the liver in general reflects a critical event in “Multiple Organ Dysfunction Syndrome” due to immunologic, regulatory and metabolic functions of liver parenchymal and non-parenchymal cells. Dysregulation of the inflammatory response, persistent microcirculatory (hypoxic) impairment or drug-induced liver injury are leading problems that result in “secondary liver failure,” i.e., acquired liver injury without underlying liver disease or deterioration of preexisting (chronic) liver disease (“Acute-on-Chronic Liver Failure”). Conventional laboratory markers, such as transaminases or bilirubin, are limited to provide insight into the complex facets of metabolic and immunologic liver dysfunction. Furthermore, inhomogeneous definitions of these entities lead to widely ranging estimates of incidence. In the present work, we review the different definitions to improve the understanding of liver dysfunction as a perpetrator (and therapeutic target) of multiple organ dysfunction syndrome in critical care. Graphic Abstracthttps://doi.org/10.1186/s13054-022-04163-1Acute liver failureAcute-on-chronic liver failureSecondary liver failureIntensive care unitMultiple organ failure |
| spellingShingle | Aritz Perez Ruiz de Garibay Andreas Kortgen Julia Leonhardt Alexander Zipprich Michael Bauer Critical care hepatology: definitions, incidence, prognosis and role of liver failure in critically ill patients Critical Care Acute liver failure Acute-on-chronic liver failure Secondary liver failure Intensive care unit Multiple organ failure |
| title | Critical care hepatology: definitions, incidence, prognosis and role of liver failure in critically ill patients |
| title_full | Critical care hepatology: definitions, incidence, prognosis and role of liver failure in critically ill patients |
| title_fullStr | Critical care hepatology: definitions, incidence, prognosis and role of liver failure in critically ill patients |
| title_full_unstemmed | Critical care hepatology: definitions, incidence, prognosis and role of liver failure in critically ill patients |
| title_short | Critical care hepatology: definitions, incidence, prognosis and role of liver failure in critically ill patients |
| title_sort | critical care hepatology definitions incidence prognosis and role of liver failure in critically ill patients |
| topic | Acute liver failure Acute-on-chronic liver failure Secondary liver failure Intensive care unit Multiple organ failure |
| url | https://doi.org/10.1186/s13054-022-04163-1 |
| work_keys_str_mv | AT aritzperezruizdegaribay criticalcarehepatologydefinitionsincidenceprognosisandroleofliverfailureincriticallyillpatients AT andreaskortgen criticalcarehepatologydefinitionsincidenceprognosisandroleofliverfailureincriticallyillpatients AT julialeonhardt criticalcarehepatologydefinitionsincidenceprognosisandroleofliverfailureincriticallyillpatients AT alexanderzipprich criticalcarehepatologydefinitionsincidenceprognosisandroleofliverfailureincriticallyillpatients AT michaelbauer criticalcarehepatologydefinitionsincidenceprognosisandroleofliverfailureincriticallyillpatients |