Incidence of hypoxic hepatitis in patients with cardiogenic shock and association with mortality

Shock of any cause leads to end organ damage due to ischaemia, especially in perfusion-sensitive organs such as the liver. In septic shock, hypoxic hepatitis (S-HH) is defined as the 20-fold increase of the upper normal limit of ASAT and ALAT and is associated with a mortality of up to 60%. However, as pathophysiology, dynamics and treatment differ between septic and cardiogenic shock, the S-HH definition may not be suitable for cardiogenic shock (CS). Therefore, we aim to evaluate if the S-HH definition is applicable in CS patients.This analysis was based on a registry of all-comer CS patients treated between 2009 and 2019 at a tertiary care centre with exclusion of minors and patients without all necessary ASAT and ALAT values.N=698. During in-hospital follow-up 386 (55.3%) patients died. S-HH was not significantly associated with in-hospital mortality in CS patients. To define HH among patients with CS (C-HH), optimal cut-off values were found to be ≥1.34-fold increase for ASAT and ≥1.51-fold increase for ALAT in serial measurements. The incidence of C-HH was 254/698 patients (36%) and C-HH showed a strong association with in-hospital mortality (OR 2.36, 95% CI: 1.61, 3.49).C-HH is a frequent and relevant comorbidity in patients with CS, although its definition varies from the established definition of HH in patients with septic shock. As C-HH contributed to excess mortality risk, these findings emphasise the need for further investigation of therapies reducing the occurrence of C-HH and also improving the associated outcome.