Antioxidant therapy on ischemic hepatitis: here we are and where do we go?

Excerpt

Ischemic hepatitis (IH) is a clinical manifestation caused by the insufficiency of hepatic flow volume and/or oxygen content to maintain hepatocytes. IH, hypoxic hepatitis and shock liver are in the same entity characterized by hepatic necrosis around the central veins, showing a transient, rapid, and considerable increase in liver enzymes (aspartate aminotransferase [AST] and alanine aminotransferase [ALT]) and significantly influences the prognosis [1‐3]. It accounts for acute liver failure (ALF), which is a sudden and severe hepatic injury defined by an international normalized ratio ≥ 1.5, neurologic dysfunction with any degree of hepatic encephalopathy (HE), no prior evidence of liver disease, and disease course of ≤ 26 weeks [4]. A recent multicenter study of 387 patients in the US reported 4 common etiologies of ALF: IH (42.7%), pancreatobiliary causes (12.3%), drug-induced liver injury (11.3%), and acute viral hepatitis (11.3%) [5]. When the data were analyzed in patients with an ALT level > 5000, acetaminophen-related liver injury and IH were the main causes (55.6% and 33.3%, respectively). Similarly, in patients with an AST level > 5000, IH and acetaminophen-related liver injury were also the main causes (60.3% and 25.9%, respectively). …