Liver histology in ICU patients dying from sepsis: a clinico-pathological study

Abstract

Aim: To determine end-stage pathologic changes in the liver of septic patients dying in the intensive care unit.

Methods: Needle liver biopsies obtained immediately after death from 15 consecutive patients with sepsis and no underlying liver disease were subjected to routine histological examination. Liver function tests and clinical monitoring measurements were also recorded.

Results: Liver biochemistries were increased in the majority of patients before death. Histology of liver biopsy specimens showed portal inflammation in 73.3%, centrilobular necrosis in 80%, lobular inflammation in 66.7%, hepatocellular apoptosis in 66.6% and cholangitis/cholangiolitis in 20% of patients. Mixed hepatitic/cholestatic type of liver injury was observed in 6/15 (40%) patients and hepatitc in 9/15 (60%). Steatosis was observed in 11/15 (73.3%) patients affecting 5%-80% of liver parenchyma. Among the histological features, the presence of portal inflammation in liver biopsy was associated with increased hospitalization in the ICU prior death (P=0.026).

Conclusion: Features of hepatitis and steatosis are the main histological findings in the liver in the majority of patients dying from sepsis.

Figure 1

Histological findings in liver biopsy specimens. A: Zone 3 (centrilobular) necrosis (HE, × 100); B: Canalicular cholestasis. Bile plugs in dilated canaliculi (black arrows). An apoptotic (acidophilic) body is present (white arrow) (HE, × 200); C: Ductular cholestasis and inflammation. Dilated bile ductules at the margin of an inflamed portal tract are filled with bile (black arrows) (HE, × 100).