Cholestatic Liver Dysfunction during Critical Illness

Abstract

Hepatic dysfunction and jaundice are traditionally viewed as late features of sepsis and other critical illnesses. Identifying true cholestatic liver dysfunction is difficult given the lack of specificity of standard laboratory tests, especially in the context of a complex systemic condition as critical illness during sepsis and other critical illnesses. The liver is a fundamental player in the host defense mechanisms as it regulates a wide range of metabolic, endocrine and immunological processes. However, inflammation and hypoxemia severely challenge the hepatic microcirculation and function. Elevated circulating levels of ALT, AST, ALP and γ-GT can further indicate liver injury and cholestasis. Inflammation-induced alterations in the transport of bile acids appear to drive bile acids and bilirubin towards the systemic circulation.