Sepsis-Associated Cholestasis: The Impact of Mitochondrial Dysfunction (A Case Report) Sepsis-Associated Cholestasis: The Impact of Mitochondrial Dysfunction (A Case Report)
Main Article Content
Keywords
Cholestasis, Critical illness, Hyperbilirubinemia, Liver failure, Sepsis
Abstract
Introduction: Hyperbilirubinemia – a condition of elevated serum bilirubin above the reference range, is common in hospitalized patients. The reasons for the increase in the bilirubin level can be pre-hepatic, hepatic, and post-hepatic. Sepsis is one of the most important causes of hyperbilirubinemia in critically ill patients.
Case report: We present a 30-year-old woman with no past medical and drug history who was admitted to the intensive care unit (ICU) due to multiple trauma and fractures due to a fall from height. During the ICU stay, the patient developed jaundice with a high increase in the bilirubin level. A diagnosis of sepsis-associated cholestasis was considered after ruling out other possible pathologies. The hyperbilirubinemia improved with the early management of sepsis concomitant supportive medical therapy.
Conclusion: Early recognition and treatment of sepsis as a cause of cholestasis should be considered in ICU patients. Drugs targeting mitochondrial function would provide rapid hepatic recovery reducing complications and mortality.
Keywords: Cholestasis, Critical illness, Hyperbilirubinemia, Liver failure, Sepsis
References
2. Joseph A, Samant H, 2019. Jaundice. StatPearls Publishing. Treasure Island. https://www.ncbi.nlm.nih.gov/books/NBK430685/.
3. Kramer L, Jordan B, Druml W, Bauer P, Metnitz PG. Incidence and prognosis of early hepatic dysfunction in critically ill patients—a prospective multicenter study. Crit. Care Med. 2007;35(4):1099-e7.
4. Brienza N, Dalfino L, Cinnella G, Diele C, Bruno F, Fiore T. Jaundice in critical illness: promoting factors of a concealed reality. Intensive Care Med. 2006;32(2):267–74.
5. Lescot T, Karvellas C, Beaussier M, Magder S. Acquired liver injury in the intensive care unit. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2012;117(4):898-904.
6. Chand N, Sanyal AJ. Sepsis‐induced cholestasis. Hepatology. 2007;45(1):230-41.
7. Moseley R. Sepsis-associated cholestasis. Elsevier; 1997.
8. Geier A, Fickert P, Trauner M. Mechanisms of disease: mechanisms and clinical implications of cholestasis in sepsis. Nat Clin Pract Gastr. 2006;3(10):574-85.
9. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017;43(3):304-77.
10. Horvatits T, Trauner M, Fuhrmann V. Hypoxic liver injury and cholestasis in critically ill patients. Curr Opin Crit Care. 2013;19(2):128-32.
11. Hiramatsu A, Aikata H, Uchikawa S, Ohya K, Kodama K, Nishida Y, et al. Levocarnitine use is associated with improvement in sarcopenia in patients with liver cirrhosis. Hepatology Communications. 2019;3(3):348-55.
12. Schulte RR, Madiwale MV, Flower A, Hochberg J, Burke MJ, McNeer JL, et al. Levocarnitine for asparaginase-induced hepatic injury: a multi-institutional case series and review of the literature. Leuk. 2018;59(10):2360-8.
13. Chughlay MF, Kramer N, Werfalli M, Spearman W, Engel ME, Cohen K. N-acetylcysteine for non-paracetamol drug-induced liver injury: a systematic review protocol. Syst. Rev. 2015;4(1):84.
14. Marik PE. Vitamin C: an essential “stress hormone” during sepsis. J. Thorac. Dis. 2020;12(Suppl 1): S84.
15. Rose C. Ammonia‐lowering strategies for the treatment of hepatic encephalopathy. Clin. Pharm. 2012;92(3):321-31.