HYPOXIC HEPATITIS IN PATIENTS WITH CARDIAC-FAILURE - INCIDENCE IN A CORONARY-CARE UNIT AND MEASUREMENT OF HEPATIC BLOOD-FLOW

The incidence of hypoxic hepatitis was prospectively studied for 1 yea r in a group of high-risk patients suffering from low cardiac output i n a coronary care unit. Hypoxic hepatitis, defined as an increase in s erum aminotransferase activity of at least 20 times the upper limit of normal without any other cause for hepatic necrosis, was observed in 20 patients. This represents 2.6% of the 766 patients admitted to the unit during this period and 21.9% of the 91 patients suffering from lo w cardiac output. Clinical, biological and hemodynamic data were compa red between 20 patients with low cardiac output and hypoxic hepatitis, and 48 patients with low cardiac output but without hypoxic hepatitis who survived more than 24 h. In these two groups of patients, hepatic blood flow was measured by galactose clearance at low concentration. Patients with hypoxic hepatitis exhibited a higher central venous pres sure (90% versus 38% - p<0.001) as well as a lower hepatic blood flow (867+/-377 ml/min versus 1429+/-644 ml/min - p=0.001). In conclusion, although it is considered a rare hepatic disorder, hypoxic hepatitis i s frequent in patients with low cardiac output admitted to the coronar y care unit, and is associated with a decrease in hepatic blood flow a nd passive hepatic venous congestion. (C) Journal of Hepatology.