Incidence of hypoxic hepatitis in patients with cardiogenic shock and association with mortality

Eur Heart J Acute Cardiovasc Care. 2023 Oct 25;12(10):663-670. doi: 10.1093/ehjacc/zuad076.


Aims: Shock of any cause leads to end-organ damage due to ischaemia, especially in perfusion-sensitive organs such as the liver. In septic shock, hypoxic hepatitis (S-HH) is defined as the 20-fold increase of the upper normal limit of aspartate aminotransferase (ASAT) and alanine aminotransferase (ALAT) and is associated with a mortality of up to 60%. However, as pathophysiology, dynamics, and treatment differ between septic and cardiogenic shock (CS), the S-HH definition may not be suitable for CS. Therefore, we aim to evaluate if the S-HH definition is applicable in CS patients.

Methods and results: This analysis was based on a registry of all-comer CS patients treated between 2009 and 2019 at a tertiary care centre with exclusion of minors and patients without all necessary ASAT and ALAT values. N = 698. During in-hospital follow-up, 386 (55.3%) patients died. The S-HH was not significantly associated with in-hospital mortality in CS patients. To define HH among patients with CS (C-HH), optimal cut-off values were found to be ≥1.34-fold increase for ASAT and ≥1.51-fold increase for ALAT in serial measurements. The incidence of C-HH was 254/698 patients (36%) and C-HH showed a strong association with in-hospital mortality (odds ratio 2.36, 95% confidence interval: 1.61, 3.49).

Conclusion: The C-HH is a frequent and relevant comorbidity in patients with CS, although its definition varies from the established definition of HH in patients with septic shock. As C-HH contributed to excess mortality risk, these findings emphasize the need for further investigation of therapies reducing the occurrence of C-HH and also improving the associated outcome.

Keywords: Cardiogenic shock; Hypoxic hepatitis; Hypoxic liver injury; Ischaemic hepatitis; Mortality; Septic shock.

MeSH terms

  • Alanine Transaminase
  • Hepatitis* / complications
  • Hepatitis* / epidemiology
  • Hospital Mortality
  • Humans
  • Incidence
  • Shock*
  • Shock, Cardiogenic / complications
  • Shock, Cardiogenic / etiology
  • Shock, Septic* / complications
  • Shock, Septic* / epidemiology


  • Alanine Transaminase