Published online Aug 8, 2017. doi: 10.4254/wjh.v9.i22.959
Peer-review started: January 20, 2017
First decision: March 13, 2017
Revised: March 24, 2017
Accepted: June 12, 2017
Article in press: June 13, 2017
Published online: August 8, 2017
To evaluate the incidence, etiology, and predictors of mortality of severe hypoxic hepatitis.
We used computerized patient records to identify consecutive cases of severe hypoxic hepatitis admitted to a tertiary hospital in Singapore over a one-year period. We defined severe hypoxic hepatitis as elevation of serum transaminases more than 100 times upper limit of normal in the clinical setting of cardiac, circulatory or respiratory failure after exclusion of other causes of hepatitis. We used multivariable regression analysis to determine predictors for mortality.
We identified 75 cases of severe hypoxic hepatitis out of 71380 hospital admissions over one year, providing an incidence of 1.05 cases per 1000 admissions. Median age was 65 years (range 19-88); 57.3% males. The most common etiologies of severe hypoxic hepatitis were acute myocardial infarction and sepsis. Fifty-three patients (71%) died during the hospitalization. The sole independent predictive factor for mortality was serum albumin measured at the onset of severe hypoxic hepatitis. Patients with low serum albumin of less than 28 g/L have more than five-fold increase risk of death (OR = 5.39, 95%CI: 1.85-15.71).
Severe hypoxic hepatitis is uncommon but has a high mortality rate. Patients with low serum albumin are at highest risk of death.
Core tip: Hypoxic hepatitis is an important cause of liver injury that is associated with a high mortality rate. We sought to evaluate the incidence, etiology and predictors of mortality of severe hypoxic hepatitis in a large tertiary-level hospital in Singapore. Our findings confirm that the prevalence and mortality rate of severe hypoxic hepatitis in Asians is consistent with previous studies. Importantly, the unique finding from our study is that low serum albumin level is an independent predictive factor for mortality in severe hypoxic hepatitis, with a five-fold increase in risk of death in patients with serum albumin less than 28 g/L.