Kosuta I, Curcic Karabaic E, Beluhan N, Zlopasa F, Babel J. Critical care hepatology: A narrative review of current concepts and management. World J Crit Care Med 2026; 15(3): 123372 [DOI: 10.5492/wjccm.123372]
Corresponding Author of This Article
Iva Kosuta, MD, PhD, Senior Research Fellow, Division of Intensive Care, Department of Internal Medicine, University Hospital Centre Zagreb, Ulica Mije Kišpatića 12, Zagreb 10000, Croatia. ivakosuta@gmail.com
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
review-article
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Kosuta I, Curcic Karabaic E, Beluhan N, Zlopasa F, Babel J. Critical care hepatology: A narrative review of current concepts and management. World J Crit Care Med 2026; 15(3): 123372 [DOI: 10.5492/wjccm.123372]
World J Crit Care Med. Sep 9, 2026; 15(3): 123372 Published online Sep 9, 2026. doi: 10.5492/wjccm.123372
Critical care hepatology: A narrative review of current concepts and management
Iva Kosuta, Ela Curcic Karabaic, Nina Beluhan, Fran Zlopasa, Jaksa Babel
Iva Kosuta, Ela Curcic Karabaic, Jaksa Babel, Division of Intensive Care, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb 10000, Croatia
Iva Kosuta, Nina Beluhan, Fran Zlopasa, School of Medicine, University of Zagreb, Zagreb 10000, Croatia
Author contributions: Kosuta I conceptualized the manuscript and led the writing process; Curcic Karabaic E, Beluhan N, and Zlopasa F contributed to the literature review, figure preparation, and critical appraisal of the content; Babel J contributed to co-drafting the manuscript and critical appraisal. All authors reviewed and approved the final version of the manuscript.
AI contribution statement: Grammarly was used solely for language editing (grammar, spelling, and clarity). It was not used to generate scientific content, interpret data, or draft conclusions. The authors take full responsibility for the integrity and content of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Iva Kosuta, MD, PhD, Senior Research Fellow, Division of Intensive Care, Department of Internal Medicine, University Hospital Centre Zagreb, Ulica Mije Kišpatića 12, Zagreb 10000, Croatia. ivakosuta@gmail.com
Received: May 18, 2026 Revised: June 2, 2026 Accepted: July 1, 2026 Published online: September 9, 2026 Processing time: 98 Days and 4 Hours
Abstract
Patients with advanced liver disease requiring intensive care were long considered to have limited benefit from aggressive treatment, given the high associated mortality. Over recent decades, outcomes have improved with advances in liver transplantation, critical care, and a better understanding of multiorgan failure. Acute liver failure and acute-on-chronic liver failure are now recognized as complex multisystem syndromes in which survival is determined not only by hepatic dysfunction but also by extrahepatic organ failure, systemic inflammation, and infection. Critical care hepatology has therefore evolved as a clinical discipline integrating hepatology, intensive care, and transplant medicine. Modern management requires adaptation of conventional intensive care strategies to the distinct pathophysiological features of liver failure syndromes, together with coordinated multidisciplinary care, often delivered within specialized liver intensive care units. Despite substantial progress, important challenges remain, including limitations of current prognostic models, ongoing debate surrounding transplant allocation policies, and complex decisions regarding transplant candidacy and futility. A structured approach to critical care hepatology may improve care integration and outcomes in critically ill patients with liver disease.
Core Tip: Critical care hepatology has emerged as a distinct multidisciplinary field integrating hepatology, intensive care, and transplant medicine. Modern management of acute liver failure and acute-on-chronic liver failure extends beyond supportive care and requires individualized strategies for circulatory dysfunction, kidney injury, infection, neurological complications, and rebalanced hemostasis. This review summarizes current concepts in organ support, antimicrobial stewardship, extracorporeal therapies, and liver transplantation, while highlighting the growing role of specialized liver-focused intensive care models in improving outcomes for critically ill patients with liver disease.
