Sepsis-Associated Cholestasis: The Impact of Mitochondrial Dysfunction (A Case Report) Sepsis-Associated Cholestasis: The Impact of Mitochondrial Dysfunction (A Case Report)

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Behzad Noroozi
Ali Mohammad Had
Bita Shahrami
Ayda Vakili Ardabili
Fatemeh Yoonesi
Kaveh Hedayati Emami
Hamid Reza Sharifnia
Mojtaba Mojtahedzadeh


Cholestasis, Critical illness, Hyperbilirubinemia, Liver failure, Sepsis


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

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1. Okolicsanyi L, Nassuato G, Muraca M, Orlando R, Iemmolo RM, Lirussi F, et al., editors. Epidemiology of unconjugated hyperbilirubinemia: revisited. New York. Thieme Medical Publishers, Inc.2008.1040538.
2. Joseph A, Samant H, 2019. Jaundice. StatPearls Publishing. Treasure Island.
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.

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