Sepsis-induced cholestasis

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  • Potential conflict of interest: Nothing to report.

Sepsis-Induced Cholestasis

To the Editor:

Hepatic dysfunction and jaundice is a common finding in patients with septic shock. In their excellent review, Dr. Nisha Chand and Prof. Arun J. Sanyal draw attention to an early and suitable management of the underlying infection as the only effective management known yet to improve hepatic dysfunction and jaundice.1

Maintenance of normoglycemia (blood glucose level between 4.4-6.1 mmol/l) with intensive insulin therapy versus conventional insulin treatment (blood glucose level between 10.0-11.1 mmol/l) was recently shown to reduce mortality in critically ill patients.2 In a subgroup of 36 patients included in this study, liver biopsies were available. In patients with intensive insulin treatment, ultrastructural and functional abnormalities of hepatic mitochondria could be prevented or reversed.3 Therefore, strict glycemic control with normoglycemia may be an additional effective procedure to prevent and/or reduce hepatic dysfunction in patients with severe sepsis and septic shock.

Kurt Lenz*, Christine Kapral*, Fritz Firlinger*, Fritz Wewalka*, * Department of Internal and Intensive Care Medicine, Hospital St. John of God, Linz, Austria.

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