Koskinas J, Gomatos IP, Tiniakos DG, Memos N, Boutsikou M, Garatzioti A, Archimandritis A, Betrosian A. Liver histology in ICU patients dying from sepsis: A clinico-pathological study. World J Gastroenterol 2008; 14(9): 1389-1393 [PMID: 18322953 DOI: 10.3748/wjg.14.1389]
Corresponding Author of This Article
John Koskinas, MD, Associate Professor, 2nd Department of Internal Medicine, Hippocration General Hospital, 114 Vas. Sofias Ave, Athens 11527, Greece. labsures@med.uoa.gr
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Rapid Communication
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World J Gastroenterol. Mar 7, 2008; 14(9): 1389-1393 Published online Mar 7, 2008. doi: 10.3748/wjg.14.1389
Liver histology in ICU patients dying from sepsis: A clinico-pathological study
John Koskinas, Ilias P Gomatos, Dina G Tiniakos, Nikolaos Memos, Maria Boutsikou, Aspasia Garatzioti, Athanasios Archimandritis, Alexander Betrosian
John Koskinas, Athanasios Archimandritis, 2nd Department of Internal Medicine, Athens Medical School, Athens 11527, Greece
Ilias P Gomatos, Nikolaos Memos, Maria Boutsikou, Laboratory of Surgical Research, 1st Department of Propaedeutic Surgery, Athens Medical School, Athens 11527, Greece
Dina G Tiniakos, Aspasia Garatzioti, Laboratory of Histology and Embryology, Athens Medical School, Athens 11527, Greece
Alexander Betrosian, Intensive Care Unit, Hippocration Hospital, Athens 11527, Greece
Author contributions: Koskinas J, Archimandritis A were responsible for idea and coordination, proofreading and manuscript revision; Tiniakos DG, Garatzioti A did histological interpretation, immunostaining and scoring immunohistochemical results; Betrosian A performed biopsies, hospitalized, gathered consents; Boutsikou M retrieved clinical data; Gomatos IP, Memos N analyzed data and wrote the paper.
Correspondence to: John Koskinas, MD, Associate Professor, 2nd Department of Internal Medicine, Hippocration General Hospital, 114 Vas. Sofias Ave, Athens 11527, Greece. labsures@med.uoa.gr
Telephone: +30-210-7774742
Fax: +30-210-7706871
Received: September 18, 2007 Revised: January 22, 2008 Published online: March 7, 2008
Abstract
AIM: To determine end-stage pathologic changes in the liver of septic patients dying in the intensive care unit.
METHODS: Needle liver biopsies obtained immediately after death from 15 consecutive patients with sepsis and no underlying liver disease were subjected to routine histological examination. Liver function tests and clinical monitoring measurements were also recorded.
RESULTS: Liver biochemistries were increased in the majority of patients before death. Histology of liver biopsy specimens showed portal inflammation in 73.3%, centrilobular necrosis in 80%, lobular inflammation in 66.7%, hepatocellular apoptosis in 66.6% and cholangitis/cholangiolitis in 20% of patients. Mixed hepatitic/cholestatic type of liver injury was observed in 6/15 (40%) patients and hepatitc in 9/15 (60%). Steatosis was observed in 11/15 (73.3%) patients affecting 5%-80% of liver parenchyma. Among the histological features, the presence of portal inflammation in liver biopsy was associated with increased hospitalization in the ICU prior death (P = 0.026).
CONCLUSION: Features of hepatitis and steatosis are the main histological findings in the liver in the majority of patients dying from sepsis.
