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Related Experiment Video

Updated: Jun 6, 2026

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Published on: May 23, 2025

Postcardiotomy Acute Liver Injury: A Retrospective Cohort.

Daniele Marianello1, Francesco Lorenzo De Matteis1, Filippo Sanfilippo2

  • 1Department of Medical Science, Surgery and Neurosciences, Cardiothoracic and Vascular Anesthesia and Intensive Care Unit, University Hospital of Siena, Siena, Italy.

Journal of Cardiothoracic and Vascular Anesthesia
|June 4, 2026
PubMed
Summary

Acute liver injury after cardiac surgery varies by definition. Hypoxic hepatitis and severe ischemic liver injury indicate higher morbidity, while acute liver failure lacks prognostic relevance as defined. Further research is needed.

Keywords:
acute liver failureacute liver injurycardiac surgery outcomecardiaothoracic anesthesiacardiopulmonary bypasshypoxic hepatitissevere ischemic early liver injury

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Area of Science:

  • Cardiology
  • Hepatology
  • Surgical Outcomes

Background:

  • Cardiac surgery with cardiopulmonary bypass (CPB) can lead to acute liver injury (ALI).
  • The diagnostic criteria for ALI vary, potentially impacting outcome assessment.
  • Understanding ALI incidence and its prognostic implications post-CPB is crucial.

Purpose of the Study:

  • To determine the incidence of ALI following cardiac surgery with CPB.
  • To evaluate ALI based on common diagnostic definitions: severe ischemic liver injury (SIELI), hypoxic hepatitis (HH), and acute liver failure (ALF).
  • To assess the association between ALI and postoperative complications and outcomes.

Main Methods:

  • Retrospective observational cohort study of 2,038 adult patients.
  • Analysis of ALI incidence using SIELI (ALT >500 IU/L), HH (AST/ALT >20x ULN), and ALF definitions.
  • Comparison of postoperative complications and outcomes between patients with and without ALI.

Main Results:

  • SIELI occurred in 0.9% of patients, HH in 1.3%, and ALF in 26.7%.
  • Patients with HH or SIELI had significantly higher rates of reoperation, bleeding, and transfusion requirements.
  • ALF, as defined, was not associated with adverse prognostic implications.

Conclusions:

  • The prognostic value of ALI post-cardiac surgery is definition-dependent.
  • HH and SIELI identify high-morbidity patient subsets.
  • Current ALF definitions lack prognostic relevance in this context; prospective studies are warranted.