What question did this study set out to answer?

This study aimed to determine the prevalence and clinical implications of ischemic hepatitis in patients with decompensated heart failure presenting to the emergency department.

April 27, 2026Open Access

Frequency of Ischemic Hepatitis in Patients Presenting to the Emergency Department with a Diagnosis of Decompensated Heart Failure and Clinical Outcomes of Patients with Ischemic Hepatitis

Key Points

This study aimed to determine the prevalence and clinical implications of ischemic hepatitis in patients with decompensated heart failure presenting to the emergency department.
Retrospective analysis of adult patients aged ≥18 years with NYHA class III-IV decompensated heart failure from January 2020 to January 2024.
Ischemic hepatitis was defined by a ≥10-fold elevation of AST and/or ALT after excluding other causes.
Clinical and laboratory data compared between patients with and without ischemic hepatitis.
11.9% of patients (45 out of 378) developed ischemic hepatitis.
IH (+) patients exhibited significantly lower blood pressures and higher heart rates, with elevated AST, ALT, INR, bilirubin, troponin, and creatinine levels (all p<0.001).
ICU admission rates were significantly higher in IH (+) patients (75.6% vs. 21.6%), with in-hospital mortality rates also higher (35.6% vs. 6.0%) (p<0.001).

Abstract

Aim: Ischemic hepatitis (IH), also called hypoxic hepatitis, is a form of acute hepatocellular injury often seen in advanced heart failure (HF) with hemodynamic compromise. However, its prevalence and prognostic significance in emergency department (ED) patients with decompensated HF remain insufficiently defined. This study aimed to investigate the prevalence of IH, clinical and laboratory outcomes, intensive care unit (ICU) admission, and in-hospital mortality associated with IH in this patient group. Material and Methods: This retrospective study included adult patients aged ≥18 years with NYHA class III-IV decompensated HF who presented to the ED between January 2020 and January 2024. IH was defined as ≥10-fold elevation of AST and/or ALT above the upper normal limit after excluding alternative hepatocellular injury causes. Clinical, laboratory, ultrasonographic data, and outcomes were compared between IH (+) and IH (–) patients. Results: Among 378 patients, 45 (11.9%) developed IH. IH (+) patients had lower systolic/diastolic blood pressures and higher heart rates, along with significantly elevated AST, ALT, INR, bilirubin, troponin, and creatinine, but reduced albumin and sodium levels, compared with IH (–) patients (all p0.001). ICU admission (75.6%, n=34) vs. (21.6%, n=72), and in-hospital mortality (35.6%, n=16) vs. (6.0%, n=20), were markedly higher in IH (+) patients (p0.001). Multivariable analysis identified elevated transaminases, INR, bilirubin, troponin, and tachycardia as independent predictors of IH. Conclusion: IH is a relatively frequent yet severe complication in ED patients with advanced decompensated HF, strongly associated with increased ICU need and mortality. Prompt recognition and hemodynamic stabilization may improve survival outcomes.

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