{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T04:10:59Z","timestamp":1788667859590,"version":"build-2803163510"},"reference-count":42,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Intensive Care Med"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hypoxic hepatitis (HH), also termed ischemic hepatitis and historically described as shock liver, is an acute liver injury syndrome in critically ill patients characterized by a rapid and marked rise in aminotransferases in the setting of circulatory, cardiac, or respiratory failure, after exclusion of other causes of acute hepatic injury. Despite its clinical relevance, the true incidence and prognostic significance of HH remain unclear. This systematic review and meta-analysis aimed to determine the pooled incidence, mortality, and outcomes of HH in critically ill patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This study followed PRISMA guidelines and was registered in PROSPERO (CRD420251088120). A systematic search of PubMed, Scopus, Web of Science, EMBASE, Cochrane, LILACS, CNKI, and Google Scholar was conducted on July 4, 2025. Randomized, cohort, and case-control studies involving critically ill adults were included. Primary outcomes were HH incidence and mortality; secondary outcomes included length of stay, organ support, and comparisons with non-HH patients. Random-effects meta-analyses were performed, with heterogeneity assessed using I\n                      <jats:sup>2<\/jats:sup>\n                      statistics.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 3236 records, 25 studies (150,928 patients) met inclusion criteria. The pooled prevalence of HH in ICU patients was 8.3%, and all-cause mortality was 64.0%. Compared with non-HH patients, HH was associated with higher all-cause mortality (RR 2.94). Mechanical ventilation (RR 2.44) and renal replacement therapy (RR 3.80) showed elevated but statistically non-significant associations. Cardiogenic shock, cardiac arrest, and sepsis were the leading reported precipitants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>HH affects a substantial proportion of ICU patients and is consistently associated with adverse outcomes and greater organ support use. However, the available evidence supports HH primarily as an associated prognostic marker rather than a proven causal determinant of mortality. Findings should be interpreted cautiously because of high heterogeneity, potential residual confounding, and possible publication bias. Standardized diagnostic criteria and prospective studies evaluating incremental prognostic value beyond established ICU severity scores are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/08850666261475587","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T16:17:21Z","timestamp":1788452241000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Hypoxic Hepatitis in Critically Ill Patients: Incidence, Clinical Characteristics, and Outcomes \u2014 A Systematic Review and Meta-Analysis"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-0121-8206","authenticated-orcid":false,"given":"Carlos David","family":"Trevilla Mart\u00ednez","sequence":"first","affiliation":[{"name":"Universidad Nacional Aut\u00f3noma de M\u00e9xico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3660-1304","authenticated-orcid":false,"given":"Yeison","family":"Cruz Castillo","sequence":"additional","affiliation":[{"name":"Universidad Aut\u00f3noma de Santo Domingo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0677-6612","authenticated-orcid":false,"given":"Mariela Denise","family":"Fermin Madera","sequence":"additional","affiliation":[{"name":"\u00c1rea de Ciencias de la Salud, Instituto Tecnol\u00f3gico de Santo Domingo (INTEC)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-7204-4181","authenticated-orcid":false,"given":"Supritha","family":"Chintamaneni","sequence":"additional","affiliation":[{"name":"HCA Houston Healthcare Kingwood, University of Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2047-3382","authenticated-orcid":false,"given":"Brenda Tatiana","family":"Camacho Ramirez","sequence":"additional","affiliation":[{"name":"School of Medicine, Universidad Industrial de Santander"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8278-9038","authenticated-orcid":false,"given":"Laura A.","family":"Gray","sequence":"additional","affiliation":[{"name":"Universidad Aut\u00f3noma de Guadalajara"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6115-3113","authenticated-orcid":false,"given":"Gabriela Flores","family":"Monar","sequence":"additional","affiliation":[{"name":"Jackson Health System"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5242-4571","authenticated-orcid":false,"given":"Bansi","family":"Sutariya","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3306-9782","authenticated-orcid":false,"given":"Camila","family":"Sanchez Cruz","sequence":"additional","affiliation":[{"name":"Universidad Nacional Aut\u00f3noma de M\u00e9xico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2237-9536","authenticated-orcid":false,"given":"Ernesto","family":"Calder\u00f3n-Martinez","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0729-0800","authenticated-orcid":false,"given":"Sushovan","family":"Guha","sequence":"additional","affiliation":[{"name":"HCA Houston Healthcare Kingwood, University of Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2716-5131","authenticated-orcid":false,"given":"Rashmi","family":"Advani","sequence":"additional","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"issue":"3","key":"e_1_3_4_2_2","first-page":"263","article-title":"Hypoxic hepatitis: A review and clinical update","volume":"4","author":"Waseem N","year":"2016","unstructured":"Waseem N, Chen PH. 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