Incidence of Ischemic Hepatitis among Patients in Medical Intensive Care Unit and Variations of Clinical and Biochemical Profiles in Patients With and Without Ischemic Hepatitis

Background: Ischemic hepatitis (IH) is a clinical syndrome encountered in critically ill patients that represents a compli-cation of underlying cardiac, circulatory or respiratory failure. Aim of Study: Information is scarce about IH in our coun-try. This study intends to explore incidence of IH, its causes, clinical, biochemical profiles and outcomes. Patients and Methods: This study was conducted over a period of 2 years (from 1st of January 2023 to 31st of Decem-ber 2024) including 1730 patients admitted in the medical in-tensive care unit (ICU) in Al-Gamhouria modern Hospital and Burj Al-Atebba Hospital at Aden governorate in Yemen. IH was diagnosed according to the following diagnostic criteria: Clinical setting, such as heart failure, circulatory or respiratory failure; Rapid rise in plasma aminotransferase level (>20 times the upper limit of normal which is 40 units/L); Exclusion of other causes of raised liver enzymes, especially viral hepatitis, drug-induced hepatopathy or autoimmune hepatitis. Results: IH incidence was 6.5%. Males comprised 61.6% of IH cases, while females 38.4%. Male: female ratio (1.6: 1). Mean age in males: 58.7±12.2 years. Mean age in females: 61.1±12.3 years. The most common underlying cause of IH was shock (54.6%) the most common type within shock associat-ed with IH was cardiogenic shock (80.3%). The most common clinical features of IH were vomiting (54.5%), right upper ab-dominal pain (52.7%) and hepatomegaly (39.3%). While overt jaundice was less common (8.1%). Characteristic laboratory Findings in IH was high aspartate to alanine aminotransferase ratio (AST/ALT ratio: 1.7) and low alanine aminotransferase to lactate dehydrogenase ratio (ALT/ LDH ratio: 0.9). Conclusion: IH should be anticipated among critical care patients with circulatory and/or respiratory compromise. It is best managed by early detection according to clinical criteria and rapid correction of underlying causes in order to prevent end organ damage.