Hypoxic hepatitis in therapeutic practice: current concepts and results of a pilot study

Background. Hypoxic hepatitis always develops secondary to life-threatening conditions. Up to 50-90% of cases of hypoxic hepatitis are associated with heart failure (both acute and decompensated chronic) and are considered an indicator of adverse prognosis. The exact pathogenesis of hypoxic hepatitis is still being elucidated, but the key mechanism lies in a critical mismatch between oxygen supply to hepatocytes and their metabolic demands, leading to centrilobular necrosis.

Objective. To summarize current knowledge on hypoxic hepatitis and present the results of a pilot retrospective study evaluating clinical and laboratory characteristics and predictors of adverse outcomes in patients of a therapeutic department.

Materials and methods. A literature review on hypoxic hepatitis was performed along with a retrospective analysis of 4.795 medical records of patients treated in the therapeutic department North-Western State Medical University n.a. I. I. Mechnikov during 2017-2019 and 2022-2024. Nine cases of hypoxic hepatitis were identified. Clinical characteristics and laboratory dynamics of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin were analyzed, as well as in-hospital mortality.

Results. The incidence of hypoxic hepatitis in the therapeutic department was 0.19% (9/4795). The median age was 65 years (41-81), and 77.8% of patients were male. Cardiovascular diseases predominated in the comorbidity profile. In-hospital mortality was 22.2% (n = 2). Peak aminotransferase levels did not differ between survivors and non-survivors. However, the absence of AST decline and an increase in total bilirubin by days 3-5 were more frequently observed in patients with fatal outcomes.

Conclusion. The prognosis of hypoxic hepatitis appears to depend not only on the peak of aminotransferase levels but also on their dynamics during treatment. Lack of AST decline by days 3-5 and persistent hyperbilirubinemia were more frequently associated with fatal outcomes in our cohort.

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