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[Hepatic dysfunction in patients with cardiogenic shock].

Philipp Kasper1, Frank Tacke2, Hans-Michael Steffen3

  • 1Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland. philipp.kasper@uk-koeln.de.

Medizinische Klinik, Intensivmedizin Und Notfallmedizin
|September 21, 2019
PubMed
Summary

Cardiogenic shock can cause liver problems like hypoxic hepatitis due to poor blood flow. Despite treatments, outcomes for patients with both conditions remain poor, highlighting a critical medical challenge.

Keywords:
Acute liver failureHypoxic hepatitisIntensive careLow-cardiac outputSecondary sclerosing cholangitis

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Area of Science:

  • Cardiology
  • Hepatology
  • Critical Care Medicine

Background:

  • Cardiogenic shock, a critical condition of low cardiac output, frequently leads to acute hepatic dysfunction.
  • End-organ hypoperfusion and hypoxia in cardiogenic shock can precipitate various liver injuries, including hypoxic hepatitis and acute liver failure.
  • Secondary sclerosing cholangitis is a severe, late complication observed in critically ill patients with cardiogenic shock and liver dysfunction.

Purpose of the Study:

  • To review the pathophysiology and clinical management of acute hepatic dysfunction associated with cardiogenic shock.
  • To highlight the spectrum of liver injuries resulting from hypoperfusion and hypoxia in cardiogenic shock.
  • To emphasize the poor prognosis despite current therapeutic strategies for patients with combined cardiogenic shock and hepatic dysfunction.

Main Methods:

  • Review of existing literature on cardiogenic shock and its impact on liver function.
  • Analysis of clinical manifestations and management strategies for hepatic dysfunction in this context.
  • Discussion of the sequelae and outcomes associated with cardiogenic shock-induced liver injury.

Main Results:

  • Cardiogenic shock causes liver dysfunction through reduced cardiac output, leading to hypoperfusion and hypoxia.
  • Common hepatic issues include hypoxic hepatitis and acute liver failure, with secondary sclerosing cholangitis as a late sequela.
  • Current management focuses on stabilizing cardiac output and optimizing liver oxygenation, but patient outcomes remain unfavorable.

Conclusions:

  • Acute hepatic dysfunction is a common and serious complication of cardiogenic shock.
  • Effective management requires addressing both cardiac function and hepatic perfusion, yet prognosis is often poor.
  • Further research is needed to improve outcomes for patients experiencing cardiogenic shock with concomitant liver compromise.