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Liver dysfunction frequently complicates the clinical picture of critical illness and leads to increased morbidity and mortality. The purpose of this review is to characterize the most frequent patterns of liver dysfunction at the intensive care unit, cholestasis and hypoxic liver injury (HLI), and to illustrate its clinical impact on outcome in critically ill patients.Liver dysfunction at the intensive care unit can be divided into two main patterns: cholestatic and HLI, also known as ischemic hepatitis or shock liver. Both hepatic dysfunctions occur frequently and early in critical illness. Major issues are the early recognition and subsequent initiation of therapeutic measures.Clinical awareness of the liver not only as a victim, but also as a trigger of multiorgan failure is of central clinical importance. Physicians have to identify the underlying factors that contribute to its development to initiate curative measures as early as possible.