Liver Injury Related to Sepsis: Transitioning from Liver Function Test Indicators to Precision Medicine Informed by Immunobiology

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Sepsis-associated liver injury (SALI) occurs in 34–46% of patients and is identified through various liver-test abnormalities.
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SALI is influenced by mechanisms such as gut–liver crosstalk and innate immune dysregulation, highlighting its complexity.
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Neutrophils primed in the gut contribute to hepatic injury during sepsis by activating liver macrophages and releasing inflammatory mediators.
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Clinical subphenotyping using routine liver tests can help stratify risk in SALI patients, aiding in bedside assessment.
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Restoration of hepatic immune tolerance may represent a future precision-medicine strategy for managing SALI.

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