Liver Injury Related to Sepsis: Transitioning from Liver Function Test Indicators to Precision Medicine Informed by Immunobiology
By
Antonios Katsounas
Emmanuel Tsochatzis
Jordi Rello
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. Related Resources & Content
