Liver Injury Related to Sepsis: Transitioning from Liver Function Test Indicators to Precision Medicine Informed by Immunobiology
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By
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Antonios Katsounas
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Emmanuel Tsochatzis
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Jordi Rello
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August 31, 2026
Clinical Scorecard: Liver Injury Related to Sepsis: Transitioning from Liver Function Test Indicators to Precision Medicine Informed by Immunobiology
At a Glance
| Category | Detail |
|---|
| Condition | Sepsis-associated liver injury (SALI) |
| Key Mechanisms | Gut-liver crosstalk, innate immune dysregulation, neutrophil activation |
| Target Population | Patients with sepsis exhibiting liver dysfunction |
| Care Setting | Intensive care unit (ICU) |
Key Highlights
- SALI occurs in 34–46% of sepsis patients.
- Routine liver tests can aid in risk stratification for SALI.
- AST-to-ALT De Ritis ratio predicts 30-day mortality in SALI.
- Loss of hepatic immune tolerance is a key feature in SALI.
- Potential therapeutic targets include NET formation and KC polarization.
Guideline-Based Recommendations
Diagnosis
- Identify SALI through liver-test abnormalities.
Management
- Consider operational clinical syndrome approach for SALI.
Monitoring & Follow-up
- Use routine liver tests for bedside risk stratification.
Risks
- Monitor for deterioration in patients with SALI.
Patient & Prescribing Data
Patients with sepsis and liver dysfunction
Therapeutic strategies may target NET formation and restore hepatic immune tolerance.
Clinical Best Practices
- Utilize AST-to-ALT De Ritis ratio for risk assessment.
- Review infection control and underlying liver conditions in SALI patients.
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