Prevalence, risk factors, and prognosis of ischemic hepatitis during venous-arterial extracorporeal membrane oxygenation

Objective Ischemic hepatitis(IH) is acute ischemic damage in liver caused by hypoxemia and hypoperfusion. However, the prevalence, risk factors and prognosis of IH during venous-arterial extracorporeal membrane oxygenation(ECMO) were rarely reported. Methods A total of 82 adult patients (≥18 years) with cardiac diseases were enrolled for venous-arterial(VA) ECMO in this study. These patients afflicted with IH and non-IH (NIH) were assigned into two groups. Results A total of 20 patients (24.4%) were afflicted with IH within 24 h during ECMO. In these patients, AST decreased over time, but the levels of total bilirubin(TBIL) increased gradually. The survival rate of IH group was significantly lower than that of NIH group (15% vs 50%, P=0.006). The incidence of acute renal failure was higher in IH group(70.0% vs 41.9%, P=0.029). More albumin was required in IH group (P=0.002). In the multivariable regression model, medical heart failure[(odds ratio, OR)=149.71, 95%CI 6.22-3 602.58, P=0.002], peak lactate (OR=1.41, 95%CI 1.14-1.76, P=0.002) and peak TBIL (OR=1.02, 95%CI 1.01-1.04, P=0.010) within the first 24 h during ECMO were risk factors for IH. The survival rate of IH group was significantly lower than that in NIH group (50% vs 15%, P=0.006). Conclusions Patients with medical heart failure, high levels of peak lactate and peak TBIL during ECMO have higher risk to develop IH. Key words: Ischemic hepatitis; Extracorporeal membrane oxygenation; Risk factors