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Review
. 2025 Aug;29(3):453-467.
doi: 10.1016/j.cld.2025.04.002. Epub 2025 May 27.

The Liver in Sepsis

Affiliations
Review

The Liver in Sepsis

Adily N Elmi et al. Clin Liver Dis. 2025 Aug.

Abstract

The liver plays a key role during sepsis. These key roles include regulating metabolism, immune and inflammatory responses, and coagulation cascades, which are essential to the systemic response to sepsis. Sepsis is characterized by tissue and organ damage, which results in multiple organ dysfunction syndrome, including hepatic dysfunction, which significantly contributes to the severity of the disease. This review examines the inflammatory, hemodynamic, and metabolic alterations in sepsis and their effects on the liver. We outline the clinical and laboratory findings of sepsis-induced liver dysfunction. Finally, we discuss current and emerging therapies, as well as timely listing for liver transplantation.

Keywords: ACLF; Acute-on chronic liver failure; Cirrhosis; Liver failure; Liver transplantation; Sepsis; Septic shock.

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Conflict of interest statement

Disclosures P.Y. Kwo: Aligos: Consultant; Altimmune: Research Grant; Amgen: Consultant; Arbutus: Consultant; Ausper Bio: Grant Support; Durect: Consultant, Stockholder; Eiger: Consultant, Grant Support; Inventiva Consultant; Galapagos; Consultant; Genentech: Consultant; Gilead, United States: Consultant, Research Grant; GSK: Consultant; HepQuant: Consultant; Madrigal, Grant Support, Consultant; Mallinckrodt: Consultant; Mirum: Consultant; Novo Nordisk, Denmark: Research Grant; Ocelot: Consultant, Grant Support; Surrozen: Grant Support: Salix; Consultant; Takeda, United States: Research Grant; Target Registries: Research Grant; Ultragenyx, United States: Research Grant.