Hypoxic Hepatitis in Critically Ill Patients: Incidence, Clinical Characteristics, and Outcomes - A Systematic Review and Meta-Analysis.

Authors

Carlos David Trevilla Martínez, Yeison Cruz Castillo, Mariela Denise Fermin Madera, Supritha Chintamaneni, Brenda Tatiana Camacho Ramirez, Laura A Gray, Gabriela Flores Monar, Bansi Sutariya, Camila Sanchez Cruz, Ernesto Calderón-Martinez, Sushovan Guha, Rashmi Advani

Published in

Journal of intensive care medicine. Pages 8850666261475587. Sep 03, 2026. Epub Sep 03, 2026.

Abstract

BackgroundHypoxic hepatitis (HH), also termed ischemic hepatitis and historically described as shock liver, is an acute liver injury syndrome in critically ill patients characterized by a rapid and marked rise in aminotransferases in the setting of circulatory, cardiac, or respiratory failure, after exclusion of other causes of acute hepatic injury. Despite its clinical relevance, the true incidence and prognostic significance of HH remain unclear. This systematic review and meta-analysis aimed to determine the pooled incidence, mortality, and outcomes of HH in critically ill patients.MethodsThis study followed PRISMA guidelines and was registered in PROSPERO (CRD420251088120). A systematic search of PubMed, Scopus, Web of Science, EMBASE, Cochrane, LILACS, CNKI, and Google Scholar was conducted on July 4, 2025. Randomized, cohort, and case-control studies involving critically ill adults were included. Primary outcomes were HH incidence and mortality; secondary outcomes included length of stay, organ support, and comparisons with non-HH patients. Random-effects meta-analyses were performed, with heterogeneity assessed using I² statistics.ResultsOf 3236 records, 25 studies (150,928 patients) met inclusion criteria. The pooled prevalence of HH in ICU patients was 8.3%, and all-cause mortality was 64.0%. Compared with non-HH patients, HH was associated with higher all-cause mortality (RR 2.94). Mechanical ventilation (RR 2.44) and renal replacement therapy (RR 3.80) showed elevated but statistically non-significant associations. Cardiogenic shock, cardiac arrest, and sepsis were the leading reported precipitants.ConclusionHH affects a substantial proportion of ICU patients and is consistently associated with adverse outcomes and greater organ support use. However, the available evidence supports HH primarily as an associated prognostic marker rather than a proven causal determinant of mortality. Findings should be interpreted cautiously because of high heterogeneity, potential residual confounding, and possible publication bias. Standardized diagnostic criteria and prospective studies evaluating incremental prognostic value beyond established ICU severity scores are needed.

PMID:
42690846
Bibliographic data and abstract were imported from PubMed on 04 Sep 2026.

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