Liver Cirrhosis as a Risk Factor for Gut Ischemia in the Intensive Care Unit

Background: Ischemic gut is a life-threatening emergency with a high mortality in intensive care units (ICUs). It often occurs as a complication in critically ill patients, leading to septic shock and multiorgan failure. Timely diagnosis is challenging but critical, as delays can result in poor outcomes.

Methods: We conducted a retrospective, single-center study in the GI and liver intensive care ward of a German university hospital from January 2012 to August 2024. Clinical, laboratory, microbiological, endoscopic, radiological, and surgical data were collected from medical records for analysis.

Results: A total of 103 critically ill patients (median age: 62 years; 57% male) with gut ischemia were treated. The median ICU stay was 14.7 days. Of these patients, 41 (40%) had liver cirrhosis, 40 (39%) developed pneumonia, and 12 (12%) had pancreatitis. Thirty patients had cardiac comorbidities. The ischemia affected the right colon in 42 cases (41%), the small bowel in 36 cases (35%), and the stomach wall in four cases. Bowel perforation occurred as a complication in 15 patients (15%). Arterial stenosis was identified in 25 patients (25%), primarily in the superior mesenteric artery (13 cases). Importantly, 28 patients (27%) had no radiological signs of ischemia, while 29 (28%) showed only bowel wall thickening. The overall mortality rate was 75%, with only 5 survivors (12%) among patients with liver cirrhosis.

Conclusion: Gut ischemia poses a significant risk, particularly in patients with liver cirrhosis. Timely diagnosis and endoscopic evaluation are essential, as radiological findings may often be inconclusive. Regular monitoring of

Publication History

Article published online:
20 January 2025