---
title: "Hypoxic Hepatitis in ICU Patients: Incidence, Clinical Features, and Outcomes — Systematic Review"
id: "pubmed-42690846"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42690846"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42690846/"
doi: "10.1177/08850666261475587"
published_at: "2026-09-03T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Hypoxic Hepatitis in ICU Patients: Incidence, Clinical Features, and Outcomes — Systematic Review
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42690846
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42690846/)
- **DOI:** [10.1177/08850666261475587](https://doi.org/10.1177%2F08850666261475587)
- **Published At:** 2026-09-03T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This systematic review and meta-analysis examined **hypoxic hepatitis** (also called ischemic hepatitis or shock liver) in critically ill adults, synthesizing data from 25 studies that enrolled 150,928 patients. - The pooled prevalence of hypoxic hepatitis in ICU populations was 8.3% and the pooled all-cause mortality among patients diagnosed with hypoxic hepatitis was 64.0%. - Hypoxic hepatitis was associated with markedly higher mortality than in patients without the condition (relative risk [RR] 2.94). - Use of organ support was greater in patients with hypoxic hepatitis; mechanical ventilation and renal replacement therapy had elevated RRs (mechanical ventilation RR 2.44; renal replacement therapy RR 3.80), although these associations were reported as statistically non-significant in the pooled analyses described. - The most commonly reported precipitants were **cardiogenic shock**, **cardiac arrest**, and **sepsis**, occurring in the context of circulatory, cardiac, or respiratory failure. - Authors followed PRISMA and registered the review in PROSPERO (CRD420251088120); searches covered multiple databases through July 4, 2025, and included randomized, cohort, and case-control studies of critically ill adults. - The evidence supports hypoxic hepatitis as a consistent prognostic marker of adverse outcomes in critically ill patients, but causality for increased mortality is not established due to potential confounding and high between-study heterogeneity. - The review highlights limitations in the literature including heterogeneity, possible publication bias, and variable diagnostic criteria; it calls for standardized diagnostic definitions and prospective studies assessing incremental prognostic value beyond established ICU severity scores.
## Clinical Analysis & Structured Key Points
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Online ahead of print. # Hypoxic Hepatitis in Critically Ill Patients: Incidence, Clinical Characteristics, and Outcomes - A Systematic Review and Meta-Analysis [Carlos David Trevilla Martínez](https://pubmed.ncbi.nlm.nih.gov/?term=Trevilla+Mart%C3%ADnez+CD&cauthor_id=42690846)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42690846/#full-view-affiliation-1 "Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Ciudad de México, México."), [Yeison Cruz Castillo](https://pubmed.ncbi.nlm.nih.gov/?term=Cruz+Castillo+Y&cauthor_id=42690846)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42690846/#full-view-affiliation-2 "Universidad Autónoma de Santo Domingo, Santo Domingo, República Dominicana."), [Mariela Denise Fermin Madera](https://pubmed.ncbi.nlm.nih.gov/?term=Fermin+Madera+MD&cauthor_id=42690846)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42690846/#full-view-affiliation-3 "Área de Ciencias de la Salud, Instituto Tecnológico de Santo Domingo \(INTEC\), Santo Domingo, República Dominicana."), [Supritha Chintamaneni](https://pubmed.ncbi.nlm.nih.gov/?term=Chintamaneni+S&cauthor_id=42690846)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42690846/#full-view-affiliation-4 "Department of Internal Medicine, HCA Houston Healthcare Kingwood, University of Houston, Kingwood, TX, USA."), [Brenda Tatiana Camacho Ramirez](https://pubmed.ncbi.nlm.nih.gov/?term=Camacho+Ramirez+BT&cauthor_id=42690846)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42690846/#full-view-affiliation-5 "School of Medicine, Universidad Industrial de Santander, Bucaramanga, Santander, Colombia."), [Laura A Gray](https://pubmed.ncbi.nlm.nih.gov/?term=Gray+LA&cauthor_id=42690846)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42690846/#full-view-affiliation-6 "Universidad Autónoma de Guadalajara, Villahermosa, Tabasco, Mexico."), [Gabriela Flores Monar](https://pubmed.ncbi.nlm.nih.gov/?term=Monar+GF&cauthor_id=42690846)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42690846/#full-view-affiliation-7 "Department of Internal Medicine, University of Miami/Jackson Health System, Miami, Florida, USA."), [Bansi Sutariya](https://pubmed.ncbi.nlm.nih.gov/?term=Sutariya+B&cauthor_id=42690846)[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42690846/#full-view-affiliation-8 "Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA."), [Camila Sanchez Cruz](https://pubmed.ncbi.nlm.nih.gov/?term=Sanchez+Cruz+C&cauthor_id=42690846)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42690846/#full-view-affiliation-1 "Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Ciudad de México, México."), [Ernesto Calderón-Martinez](https://pubmed.ncbi.nlm.nih.gov/?term=Calder%C3%B3n-Martinez+E&cauthor_id=42690846)[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42690846/#full-view-affiliation-8 "Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA."), [Sushovan Guha](https://pubmed.ncbi.nlm.nih.gov/?term=Guha+S&cauthor_id=42690846)[ 9 ](https://pubmed.ncbi.nlm.nih.gov/42690846/#full-view-affiliation-9 "Department of Gastroenterology, HCA Houston Healthcare Kingwood, University of Houston, Kingwood, TX, USA."), [Rashmi Advani](https://pubmed.ncbi.nlm.nih.gov/?term=Advani+R&cauthor_id=42690846)[ 10 ](https://pubmed.ncbi.nlm.nih.gov/42690846/#full-view-affiliation-10 "Department of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.") Affiliations Expand ### Affiliations * 1 Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Ciudad de México, México. * 2 Universidad Autónoma de Santo Domingo, Santo Domingo, República Dominicana. * 3 Área de Ciencias de la Salud, Instituto Tecnológico de Santo Domingo (INTEC), Santo Domingo, República Dominicana. * 4 Department of Internal Medicine, HCA Houston Healthcare Kingwood, University of Houston, Kingwood, TX, USA. * 5 School of Medicine, Universidad Industrial de Santander, Bucaramanga, Santander, Colombia. * 6 Universidad Autónoma de Guadalajara, Villahermosa, Tabasco, Mexico. * 7 Department of Internal Medicine, University of Miami/Jackson Health System, Miami, Florida, USA. * 8 Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA. * 9 Department of Gastroenterology, HCA Houston Healthcare Kingwood, University of Houston, Kingwood, TX, USA. * 10 Department of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. * PMID: **42690846** * DOI: [ 10.1177/08850666261475587 ](https://doi.org/10.1177/08850666261475587) Item in Clipboard Review # Hypoxic Hepatitis in Critically Ill Patients: Incidence, Clinical Characteristics, and Outcomes - A Systematic Review and Meta-Analysis Carlos David Trevilla Martínez et al. J Intensive Care Med. 2026. Show details Display options Display options Format Abstract PubMed PMID J Intensive Care Med Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22J+Intensive+Care+Med%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22J+Intensive+Care+Med%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42690846/) . 2026 Sep 3:8850666261475587. doi: 10.1177/08850666261475587. Online ahead of print. ### Authors [Carlos David Trevilla Martínez](https://pubmed.ncbi.nlm.nih.gov/?term=Trevilla+Mart%C3%ADnez+CD&cauthor_id=42690846)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42690846/#short-view-affiliation-1 "Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Ciudad de México, México."), [Yeison Cruz Castillo](https://pubmed.ncbi.nlm.nih.gov/?term=Cruz+Castillo+Y&cauthor_id=42690846)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42690846/#short-view-affiliation-2 "Universidad Autónoma de Santo Domingo, Santo Domingo, República Dominicana."), [Mariela Denise Fermin Madera](https://pubmed.ncbi.nlm.nih.gov/?term=Fermin+Madera+MD&cauthor_id=42690846)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42690846/#short-view-affiliation-3 "Área de Ciencias de la Salud, Instituto Tecnológico de Santo Domingo \(INTEC\), Santo Domingo, República Dominicana."), [Supritha Chintamaneni](https://pubmed.ncbi.nlm.nih.gov/?term=Chintamaneni+S&cauthor_id=42690846)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42690846/#short-view-affiliation-4 "Department of Internal Medicine, HCA Houston Healthcare Kingwood, University of Houston, Kingwood, TX, USA."), [Brenda Tatiana Camacho Ramirez](https://pubmed.ncbi.nlm.nih.gov/?term=Camacho+Ramirez+BT&cauthor_id=42690846)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42690846/#short-view-affiliation-5 "School of Medicine, Universidad Industrial de Santander, Bucaramanga, Santander, Colombia."), [Laura A Gray](https://pubmed.ncbi.nlm.nih.gov/?term=Gray+LA&cauthor_id=42690846)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42690846/#short-view-affiliation-6 "Universidad Autónoma de Guadalajara, Villahermosa, Tabasco, Mexico."), [Gabriela Flores Monar](https://pubmed.ncbi.nlm.nih.gov/?term=Monar+GF&cauthor_id=42690846)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42690846/#short-view-affiliation-7 "Department of Internal Medicine, University of Miami/Jackson Health System, Miami, Florida, USA."), [Bansi Sutariya](https://pubmed.ncbi.nlm.nih.gov/?term=Sutariya+B&cauthor_id=42690846)[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42690846/#short-view-affiliation-8 "Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA."), [Camila Sanchez Cruz](https://pubmed.ncbi.nlm.nih.gov/?term=Sanchez+Cruz+C&cauthor_id=42690846)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42690846/#short-view-affiliation-1 "Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Ciudad de México, México."), [Ernesto Calderón-Martinez](https://pubmed.ncbi.nlm.nih.gov/?term=Calder%C3%B3n-Martinez+E&cauthor_id=42690846)[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42690846/#short-view-affiliation-8 "Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA."), [Sushovan Guha](https://pubmed.ncbi.nlm.nih.gov/?term=Guha+S&cauthor_id=42690846)[ 9 ](https://pubmed.ncbi.nlm.nih.gov/42690846/#short-view-affiliation-9 "Department of Gastroenterology, HCA Houston Healthcare Kingwood, University of Houston, Kingwood, TX, USA."), [Rashmi Advani](https://pubmed.ncbi.nlm.nih.gov/?term=Advani+R&cauthor_id=42690846)[ 10 ](https://pubmed.ncbi.nlm.nih.gov/42690846/#short-view-affiliation-10 "Department of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.") ### Affiliations * 1 Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Ciudad de México, México. * 2 Universidad Autónoma de Santo Domingo, Santo Domingo, República Dominicana. * 3 Área de Ciencias de la Salud, Instituto Tecnológico de Santo Domingo (INTEC), Santo Domingo, República Dominicana. * 4 Department of Internal Medicine, HCA Houston Healthcare Kingwood, University of Houston, Kingwood, TX, USA. * 5 School of Medicine, Universidad Industrial de Santander, Bucaramanga, Santander, Colombia. * 6 Universidad Autónoma de Guadalajara, Villahermosa, Tabasco, Mexico. * 7 Department of Internal Medicine, University of Miami/Jackson Health System, Miami, Florida, USA. * 8 Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA. * 9 Department of Gastroenterology, HCA Houston Healthcare Kingwood, University of Houston, Kingwood, TX, USA. * 10 Department of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. * PMID: **42690846** * DOI: [ 10.1177/08850666261475587 ](https://doi.org/10.1177/08850666261475587) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract BackgroundHypoxic hepatitis (HH), also termed ischemic hepatitis and historically described as shock liver, is an acute liver injury syndrome in critically ill patients characterized by a rapid and marked rise in aminotransferases in the setting of circulatory, cardiac, or respiratory failure, after exclusion of other causes of acute hepatic injury. Despite its clinical relevance, the true incidence and prognostic significance of HH remain unclear. This systematic review and meta-analysis aimed to determine the pooled incidence, mortality, and outcomes of HH in critically ill patients.MethodsThis study followed PRISMA guidelines and was registered in PROSPERO (CRD420251088120). A systematic search of PubMed, Scopus, Web of Science, EMBASE, Cochrane, LILACS, CNKI, and Google Scholar was conducted on July 4, 2025. Randomized, cohort, and case-control studies involving critically ill adults were included. Primary outcomes were HH incidence and mortality; secondary outcomes included length of stay, organ support, and comparisons with non-HH patients. Random-effects meta-analyses were performed, with heterogeneity assessed using I2 statistics.ResultsOf 3236 records, 25 studies (150,928 patients) met inclusion criteria. The pooled prevalence of HH in ICU patients was 8.3%, and all-cause mortality was 64.0%. Compared with non-HH patients, HH was associated with higher all-cause mortality (RR 2.94). Mechanical ventilation (RR 2.44) and renal replacement therapy (RR 3.80) showed elevated but statistically non-significant associations. Cardiogenic shock, cardiac arrest, and sepsis were the leading reported precipitants.ConclusionHH affects a substantial proportion of ICU patients and is consistently associated with adverse outcomes and greater organ support use. However, the available evidence supports HH primarily as an associated prognostic marker rather than a proven causal determinant of mortality. Findings should be interpreted cautiously because of high heterogeneity, potential residual confounding, and possible publication bias. Standardized diagnostic criteria and prospective studies evaluating incremental prognostic value beyond established ICU severity scores are needed. **Keywords:** critical illness; intensive care unit; ischemic hepatitis; mortality. 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