Jaundice and Abnormal Liver Function Tests

Liver “function tests” include markers of liver injury, hepatobiliary abnormalitities, and synthetic function. Hepatic dysfunction is a marker of morbidity and mortality in critically ill patients. Hepatic dysfunction in the critical care patient may reflect a primary liver insult or more typically their underlying acute systemic dysregulation. Acute ischemic injury from circulatory shock, drug-induced liver injury, and intrahepatic cholestasis from sepsis or systemic inflammatory response syndrome (SIRS) are the most common causes of hepatic dysfunction in the intensive care unit. Unrecognized chronic liver disease can have an initial presentation as acute-on-chornic liver failure (ACLF) with index complications such as fluid overload, variceal hemorrhage, or hepatic encephalopathy. COVID-19 infection has been implicated in liver injury due to immune-mediated inflammation, sepsis, drug-induced injury, and/or viral replication in liver cells. Assessment of liver injury in the critical care setting can be challenging, but prompt recognition and identification of etiology can prevent unnecessary invasive testing and facilitate logical management.