P4572 - Investigating Clinical Characteristics and Outcomes of Hypoxic Hepatitis: A Single Institutional Study

Zahra Dossaji, DO¹, Mark Hsu, MD¹, Kyaw Min Tun, DO², Adam Khattak, DO¹, Jonathan Hansen, DO¹, Kavita Batra, PhD¹, Vignan Manne, MD^3
1Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas, NV; ²Creighton University School of Medicine, Las Vegas, NV; ³Kirk Kirkorian School of Medicine, Las Vegas, NV

Introduction: Hypoxic Hepatitis (HH) or shock liver, is a well-known cause of significantly elevated liver aminotransferases among critically ill patients with a mortality rate of 60%. Early identification of HH and addressing its underlying cause may improve the overall prognosis. To date, no studies investigated the impact of pharmacotherapy on mortality rates secondary to different causes of HH. Therefore, this study aims to investigate the clinical characteristics, treatment and hospital outcomes of potential causes of HH.

Methods: The sample consisted of adults admitted to the University Medical Center between 12/01/2017 and 10/01/2022 with a confirmed diagnosis of HH. HH was defined as a peak aspartate aminotransferase (AST) or alanine aminotransferase (ALT) >20 times the upper limit of normal after the exclusion of other etiologies of elevated liver enzymes, such as drug-induced liver injury, alcoholic hepatitis, and cirrhosis. Chi-square and one-way ANOVA were utilized to investigate group differences.

Results: Among a total of 320 patients with a mean age of 58.8 ± 16.2 years, 65.6% were males. HH was observed in 1.03% of the ICU admissions. Episodes were related to five primary etiologies: cardiac arrest (22.5%), cardiogenic shock (26.9%), distributive shock (24.4%), hypovolemic shock (17.2%), and respiratory failure (9.1%). Only eight episodes (2.5%) did not require ICU admission. Mortality rates differed significantly among the causes, with an overall mortality rate of 58.4% (p< 0.001). Cardiogenic shock had the lowest mortality rate (36.0%) compared to hypovolemic shock (61.8%) and distributive shock (60.3%) (p< 0.001). Overall mortality rates decreased from 58.4% to 46.8% in patients treated with N-acetylcysteine (n=47), with a majority (n=17) in the cardiogenic shock group. Higher right ventricular systolic pressure (RVSP) was noted in the respiratory failure group (55.8 ± 22.6). The lowest levels of total bilirubin and INR were noted in the cardiac arrest and respiratory failure groups.

Discussion: The main causes of HH include cardiogenic shock and distributive shock. In addition, underlying physiological changes, such as elevated RVSP in respiratory failure, may predispose patients to developing HH. Early management with N-acetylcysteine can improve outcomes. Future studies will investigate whether patients with underlying comorbidities or metabolic dysfunction-associated steatotic liver disease are at a higher risk of developing HH.


Disclosures:


Zahra Dossaji, DO¹, Mark Hsu, MD¹, Kyaw Min Tun, DO², Adam Khattak, DO¹, Jonathan Hansen, DO¹, Kavita Batra, PhD¹, Vignan Manne, MD³. P4572 - Investigating Clinical Characteristics and Outcomes of Hypoxic Hepatitis: A Single Institutional Study, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.