Hypoxic
hepatitis (HH) is the most frequent cause of acute liver injury in
critically ill patients. No clinical data exist about new onset of
jaundice in patients with HH. This study aimed to evaluate the incidence and clinical effect of
jaundice in
critically ill patients with HH. Two hundred and six consecutive patients with HH were screened for the development of
jaundice during the course of HH. Individuals with preexisting
jaundice or
liver cirrhosis at the time of admission (n = 31) were excluded from analysis.
Jaundice was diagnosed in patients with plasma total
bilirubin levels >3 mg/dL. One-year-survival,
infections, and cardiopulmonary, gastrointestinal (GI), renal, and hepatic complications were prospectively documented. New onset of
jaundice occurred in 63 of 175 patients with HH (36%). In patients who survived the acute event of HH, median duration of
jaundice was 6 days (interquartile range, 3-8). Patients who developed
jaundice (group 1) needed vasopressor treatment (P < 0.05),
renal replacement therapy (P < 0.05), and
mechanical ventilation (P < 0.05) more often and had a higher maximal administered dose of
norepinephrine (P < 0.05), compared to patients without
jaundice (group 2). One-year survival rate was significantly lower in group 1, compared to group 2 (8% versus 25%, respectively; P < 0.05). Occurrence of
jaundice was associated with an increased frequency of complications during follow-up (54% in group 1 versus 35% in group 2; P < 0.05). In particular,
infections as well as renal and GI complications occurred more frequently in group 1 during follow-up.
CONCLUSION: