Shock liver is a sudden, acute type of liver disease that can cause liver failure. It happens when reduced blood flow to the liver causes liver cells to die. It is most common among people who have other serious medical conditions.
Cardiac shock, respiratory failure, and septic shock are the main causes of shock liver. Most people who develop this condition are already very ill.
Shock liver can be fatal for
People use many names to refer to shock liver, including ischemic hepatitis and hypoxic hepatitis. Shock liver means that blood flow to the liver slows or becomes blocked.
Read on to learn more about shock liver, including its causes, symptoms, treatment, and outlook.
Shock liver can be a sign of a serious underlying illness — often heart disease or heart failure.
Other conditions that may increase the risk include:
- very low blood pressure
- sepsis from a serious infection
- sickle cell crisis in a person with sickle cell disease
- damage to liver blood vessels during a liver transplant
Occasionally, shock liver may develop suddenly due to another acute illness, such as poisoning from medication or carbon monoxide.
People who develop shock liver are often already very ill and may be in the intensive care unit (ICU). It is a common cause of liver dysfunction in ICUs, accounting for about 2.5% of ICU admissions.
Most people who develop shock liver have heart disease and a heart health event, such as heart surgery or a heart attack, that can precede the liver shock.
According to a 2021 review reporting on prior research, one study showed that 78.2% of participants with shock liver had a cardiac event prior to their diagnosis, with 23.4% experiencing sepsis and 52.9% having an episode of very low blood pressure.
The symptoms of liver shock are similar to those of other liver diseases and may include:
Some other conditions can cause similar liver symptoms.
Comprehensive testing, including daily monitoring of bloodwork, can help distinguish shock liver from
- acute viral hepatitis, or a worsening of chronic hepatitis
- autoimmune hepatitis
- liver injury
- liver trauma
- gallstone obstruction
- toxic hepatitis from medication or drugs
- heart disease and heart failure
A doctor may suspect shock liver in someone with sudden symptoms of liver disease, especially if they have serious underlying illnesses.
A doctor may order additional tests, such as a liver ultrasound, to rule out other potential causes of a person’s symptoms.
They may also use imaging tests, such as an MRI, to identify blockages in the liver and their potential causes.
Criteria for diagnosis
A diagnosis of shock liver
- A doctor to suspect that a person has cardiac, circulatory, or respiratory failure.
- Tests that show an abrupt increase in serum aminotransferase, though this may be short-lived.
- Exclusion of other causes of liver cell damage — for example, viral hepatitis or drug-induced hepatitis.
Diagnosing this condition begins with bloodwork to check for signs of liver injury. A doctor will likely repeat bloodwork over several days.
People also usually have cardiac symptoms. Liver enzyme levels can also rise in the following order: AST (aspartate aminotransferase), then ALT (alanine transaminase). AST levels usually remain higher than ALT.
In about 50% of cases, shock liver can cause a sudden and dramatic increase in AST.
Doctors may also look at prothrombin time (PT), a test to measure the time it takes for blood to clot.
Treatment focuses on addressing the underlying cause of liver shock. The goal is to restore blood flow to the liver. Doctors call this hepatic reperfusion.
For example, a 2020 paper details the case of a 21-year-old who developed shock liver following cardiogenic shock. Surgery to replace the mitral valve restored their liver function.
When heart failure can cause liver shock, doctors may recommend drugs such as diuretics or vasoconstrictors to restore blood flow.
When septic shock is the cause of liver shock, a doctor may prescribe antibiotics — usually intravenously through a vein.
Doctors can also prioritize managing symptoms through oxygen therapy and ongoing monitoring in the hospital.
Shock liver is usually a complication of another illness, such as systemic infection or heart failure. No specific prevention strategy can prevent shock liver. However, preventing other illnesses may reduce the risk of shock liver.
Shock liver is a very dangerous condition with a high death rate of 40–80%.
In most cases, death is not a result of liver failure
Certain factors increase the risk of death, which can
- advanced age
- a high risk score associated with the underlying condition that led to shock liver
- persistently elevated aminotransferase and LDH levels
- the international normalized ratio (INR) level is higher than 2. This is a type of calculation based on PT results.
- bilirubin level higher than 3 milligrams per deciliter, along with worsening jaundice
- using vasopressors
- acute kidney injury
Prompt diagnosis of this condition can help improve a person’s outlook.
The main risk of shock liver is liver failure. Decreased blood flow to the liver damages the cells of the liver. With enough damage, the liver loses the ability to function.
Without treatment, liver failure can be fatal.
A person might need a liver transplant if the damage to the liver is severe enough.
People with shock liver are often already severely ill. Anyone who experiences signs of shock liver or of another serious illness should consult a doctor for urgent medical attention.
Some symptoms to be aware of include:
- jaundice, such as yellow skin or eyes, or very dark urine
- feeling very sick
- upper abdominal pain and tenderness
- chest pain
- sudden high fever
- symptoms of sepsis, such as low blood pressure and feeling very ill
Shock liver, or ischemic hepatitis, is a serious and life threatening condition. It is often a sign that an underlying medical condition, such as heart failure, is worsening.
Treating shock liver requires managing the underlying condition and preventing liver failure. A person with shock liver may need to stay in the hospital for monitoring and will likely need ongoing treatment.
People who think they have liver health issues should treat their symptoms as an emergency, especially if they have an underlying health condition such as heart failure or heart disease.