Liver involvement in systemic infection

Table 1 Mechanism of Jaundice in Sepsis

Increased bilirubin load

Hemolysis

Red blood cells lysed by bacterial products (e.g., exotoxin)

Red blood cells lysed by immunological mechanisms

Hepatic dysfunction

Hepatocellular injury (hepatitis and/or necrosis)

Hepatic ischemia

Decreased bilirubin uptake; dysfunction of basolateral transport (e.g., NTCP)

Decreased transport of conjugated bilirubin; dysfunction of canalicular transport (e.g., BSEP, MRP2)

Decreased bile flow

NTCP: Na⁺/taurocholate cotransporting polypeptide; BSEP: Bile salt export pump; MRP2: Multidrug-resistance-associated protein 2.