Cholestatic Alterations in the Critically Ill: Some New Light on an Old Problem

Area of Science:

• Critical care medicine
• Hepatology
• Biochemistry

Background:

• Liver dysfunction and jaundice are typically late signs of critical illness.
• Early cholestatic alterations in critical illness are often subtle biochemical changes.

Purpose of the Study:

• To investigate the early occurrence and mechanisms of cholestatic alterations in critical illnesses.
• To determine the clinical significance of early cholestasis in critically ill patients.

Main Methods:

• Analysis of biochemical liver tests and cholestatic markers in critically ill patients.
• Review of the pathophysiology of bile acid and bilirubin transport during critical illness.

Main Results:

• Inflammation alters bile acid (BA) transport, leading to increased systemic BA and bilirubin levels.
• Early cholestatic changes may precede overt liver dysfunction but indicate a complicated illness course if sustained.

Conclusions:

• Identifying true cholestatic liver dysfunction in critical illness is challenging due to non-specific tests.
• Sustained high cholestatic markers necessitate close monitoring and suggest a complex illness trajectory.
• Preventive strategies include managing inflammation, hypoxia, hyperglycemia, and judicious use of nutrition and drugs.