Liver intensive care for the general intensivist

Abstract

Liver injury or failure is observed in up to 20% of patients admitted to the intensive care unit and is associated with poor prognosis. Timely recognition and initiation of appropriate management are the most important steps in minimising adverse outcome for patients. Distinguishing between primary or secondary liver failure, and between acute or chronic liver disease aids appropriate management. This can be challenging in cases of limited history and delayed or protracted presentation. Liver failure should be considered as a multisystem disease, with numerous systemic manifestations that must be considered to optimise supportive intensive care unit care. In this narrative review, we summarise an approach to patients with deranged liver biochemistry admitted to a general intensive care unit. We focus on interpretation of patterns of deranged liver biochemistry and the necessary investigations required to identify the related aetiologies. We also propose an evidence-based approach to the management of liver failure and its extrahepatic manifestations. This review, in addition, clarifies when to seek expert advice or refer patients to a tertiary centre.