Septic Hepatopathy: Incidence, Characteristics, and Outcomes among Critically Ill Patients In A Two-year Retrospective Analysis

INTRODUCTION: Septic hepatopathy, defined as liver dysfunction occurring in the setting of systemic infection, is a recognised complication in critically ill patients with sepsis.(2,4) Its incidence and severity have been associated with worsening clinical outcomes and increased mortality rates.(1,3) Understanding the frequency and patterns of hepatopathy and identifying the patient populations most at risk are essential steps toward improving prognostication and guiding therapeutic interventions.(5,7) This study aimed to determine the incidence of septic hepatopathy among a cohort of critically ill septic patients and to assess its impact on clinical outcomes within an intensive care setting. OBJECTIVES: This study aimed to determine the incidence and clinical characteristics of septic hepatopathy and its association with outcomes among critically ill septic patients admitted to the Intensive Care Unit (ICU). MATERIALS AND METHODS: A retrospective analysis was conducted on all patients admitted with sepsis to the ICU of a tertiary care centre over two years. Data were retrieved from electronic medical records, including demographic details, clinical variables, and laboratory findings. A total of 1350 septic patients were reviewed. Septic hepatopathy was defined according to previously established criteria, focusing on elevations in liver enzymes (AST, ALT), bilirubin, and evidence of cholestasis. Statistical analyses included descriptive measures and comparisons using chi-square and t-tests, as appropriate. RESULTS: Among the 1350 patients, 469 (34.7%) exhibited septic hepatopathy. Patients with septic hepatopathy were older (mean age: 68 ± 12 years) and more frequently had pre-existing liver disease (19% vs. 8%, p<0.05) compared to those without liver involvement. The majority of cases demonstrated hepatocellular patterns of injury (54%), followed by cholestatic (31%) and mixed-pattern liver injury (15%). Patients with septic hepatopathy had significantly higher severity of illness scores (APACHE II median: 24 vs. 19, p<0.01) and a longer ICU length of stay (median: 14 vs. 9 days, p<0.05). Overall, ICU mortality was higher in the hepatopathy group (39% vs. 22%, p<0.01). After adjusting for confounders, septic hepatopathy remained an independent predictor of mortality (adjusted odds ratio: 1.9, 95% CI: 1.4–2.5). Biochemical markers such as elevated AST and ALT correlated with severity, while the presence of early cholestasis on admission was associated with increased mortality risk. These findings highlight the importance of early recognition, supportive management, and close liver function monitoring in patients with sepsis. DISCUSSIONS/CONCLUSIONS: This study found that approximately one-third of septic patients developed hepatopathy, with significant implications for ICU stay and mortality risk. Septic hepatopathy emerged as an independent predictor of poor outcomes.(6) Early detection and targeted interventions may improve prognosis and resource utilisation in critically ill patients with sepsis-associated liver injury.