Hypoxic hepatitis in survivors of cardiac arrest: A systematic review and meta-analysis.

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus Pub Date : 2024-12-03 eCollection Date: 2024-12-01 DOI:10.1016/j.resplu.2024.100834

Ya-Bei Gao, Jia-Heng Shi, Da-Xing Yu, Hui-Bin Huang

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Abstract

Background: Hypoxic hepatitis (HH) is commonly seen in critically ill patients, such as those with cardiac shock, sepsis, and respiratory failure. However, data are limited regarding its impact on the prognosis of patients with cardiac arrest (CA).

Methods: We conducted a systematic review and meta-analysis of studies from PubMed, EMBASE, and the Cochrane Library from inception to July 30, 2024. Studies were included if they focused on adult CA patients with HH compared to controls and had a clear definition of HH (defined as a rapid elevation in liver enzyme levels > 20 times the upper limit of normal after CA). The primary outcome was all-cause mortality.Subgroup analyses, sensitivity analyses, and generic inverse variance analyses were conducted.

Results: Six studies with 3,005 adults were included. The median prevalence of HH was 16.3 % (ranging from 7.2 to 24.7 %). Overall, patients with HH had a significantly higher risk of all-cause mortality than those without (odds ratio [OR] = 3.49; 95 % CI, 2.19-5.57; P < 0.00001). This finding was confirmed in subgroups, sensitivity analyses, and regression analyses. HH patients were more likely to have a poor neurological outcome (OR = 2.73; 95 % CI, 1.37-5.42; P = 0.004), post-CA shock (OR = 5.77; 95 % CI, 1.76-18.94; P = 0.004), cardiac failure (OR = 35.84; 95 % CI, 6.02-213.31; P < 0.0001), and higher lactate levels (mean difference [MD] = 4.10 mmol/L; 95 % CI, 2.89-5.31; P < 0.00001). In addition, HH required more continuous renal replacement therapy (OR = 4.19; 95 % CI, 3.02-5.82; P < 0.00001), vasopressor therapy, time to return of spontaneous circulation (MD = 5.0 min; 95 % CI, 3.02-6.97; P < 0.00001) but not mechanical ventilation (OR = 1.40; 95 % CI, 1.00-1.97; P = 0.05).

Conclusions: Hypoxic hepatitis is not a rare complication after CA, and was independently associated with all-cause mortality. Further prospective, well-designed studies are needed to validate our findings.

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心脏骤停幸存者的缺氧性肝炎：系统回顾和荟萃分析。

背景：缺氧性肝炎（HH）常见于危重患者，如心源性休克、败血症和呼吸衰竭。然而，关于其对心脏骤停（CA）患者预后影响的数据有限。方法：我们对PubMed、EMBASE和Cochrane图书馆从成立到2024年7月30日的研究进行了系统回顾和荟萃分析。如果研究的重点是与对照组相比HH的成年CA患者，并且HH的定义明确（定义为CA后肝酶水平快速升高bbb20倍于正常上限），则纳入研究。主要结局为全因死亡率。进行亚组分析、敏感性分析和一般逆方差分析。结果：纳入了6项涉及3,005名成人的研究。HH的中位患病率为16.3%（范围从7.2%到24.7%）。总体而言，HH患者的全因死亡风险显著高于无HH患者(优势比[OR] = 3.49；95% ci, 2.19-5.57；P = 0.004)， ca后休克(OR = 5.77；95% ci, 1.76-18.94；P = 0.004)，心力衰竭(OR = 35.84；95% ci, 6.02-213.31；p p p p = 0.05)。结论：缺氧性肝炎不是CA后的罕见并发症，并且与全因死亡率独立相关。需要进一步的前瞻性、精心设计的研究来验证我们的发现。

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