Frequency and Prognostic Significance of Abnormal Liver Function Tests in Patients With Cardiogenic Shock

医学 内科学 心源性休克 肝功能检查 胃肠病学 比例危险模型 胆红素 休克(循环) 肝功能 心脏病学 心肌梗塞
作者
Toni Jäntti,Tuukka Tarvasmäki,Veli‐Pekka Harjola,John Parissis,Kari Pulkki,Alessandro Sionís,José Silva‐Cardoso,Lars Køber,Marek Banaszewski,Jindřich Špinar,Valentin Fuhrmann,Jukka Tolonen,Valentina Carubelli,Salvatore DiSomma,Alexandre Mebazaa,Johan Lassus,Katerina Koniari,Astrinos Voumvourakis,Apostolos Karavidas,Jordi Sans‐Roselló,Montserrat Vilà,Albert Durán-Cambra,Marco Metra,Michela Bulgari,Valentina Lazzarini,Jiří Pařenica,Roman Štípal,Ondřej Ludka,Marie Palsuva,Eva Ganovská,Petr Kuběna,Matias Greve Lindholm,Christian Hassager,Tom Bäcklund,Raija Jurkko,Kristiina Järvinen,Tuomo Nieminen,Kari Pulkki,Leena Soininen,Reijo Sund,Ilkka Tierala,Jukka Tolonen,Marjut Varpula,Tuomas Korva,Anne Pitkälä,Rossella Marino,Alexandra Sousa,Carla Sousa,Mariana Paiva,Inês Rangel,Rui Almeida,Teresa Pinho,Maria Júlia Maciel,Janina Stępińska,Anna Skrobisz,Piotr Góral
出处
期刊:American Journal of Cardiology [Elsevier BV]
卷期号:120 (7): 1090-1097 被引量:18
标识
DOI:10.1016/j.amjcard.2017.06.049
摘要

Cardiogenic shock (CS) is a cardiac emergency often leading to multiple organ failure and death. Assessing organ dysfunction and appropriate risk stratification are central for the optimal management of these patients. The purpose of this study was to assess the prevalence of abnormal liver function tests (LFTs), as well as early changes of LFTs and their impact on outcome in CS. We measured LFTs in 178 patients in CS from serial blood samples taken at 0 hours, 12 hours, and 24 hours. The associations of LFT abnormalities and their early changes with all-cause 90-day mortality were estimated using Fisher's exact test and Cox proportional hazards regression analysis. Baseline alanine aminotransferase (ALT) was abnormal in 58% of the patients, more frequently in nonsurvivors. Abnormalities in other LFTs analyzed (alkaline phosphatase, gamma-glutamyl transferase, and total bilirubin) were not associated with short-term mortality. An increase in ALT of >20% within 24 hours (ΔALT>+20%) was observed in 24% of patients. ΔALT>+20% was associated with a more than 2-fold increase in mortality compared with those with stable or decreasing ALT (70% and 28%, p <0.001). Multivariable regression analysis showed that ΔALT>+20% was associated with increased 90-day mortality independent of other known risk factors. In conclusion, an increase in ALT in the initial phase was seen in 1/4 of patients in CS and was independently associated with 90-day mortality. This finding suggests that serial ALT measurements should be incorporated in the clinical assessment of patients in CS. Cardiogenic shock (CS) is a cardiac emergency often leading to multiple organ failure and death. Assessing organ dysfunction and appropriate risk stratification are central for the optimal management of these patients. The purpose of this study was to assess the prevalence of abnormal liver function tests (LFTs), as well as early changes of LFTs and their impact on outcome in CS. We measured LFTs in 178 patients in CS from serial blood samples taken at 0 hours, 12 hours, and 24 hours. The associations of LFT abnormalities and their early changes with all-cause 90-day mortality were estimated using Fisher's exact test and Cox proportional hazards regression analysis. Baseline alanine aminotransferase (ALT) was abnormal in 58% of the patients, more frequently in nonsurvivors. Abnormalities in other LFTs analyzed (alkaline phosphatase, gamma-glutamyl transferase, and total bilirubin) were not associated with short-term mortality. An increase in ALT of >20% within 24 hours (ΔALT>+20%) was observed in 24% of patients. ΔALT>+20% was associated with a more than 2-fold increase in mortality compared with those with stable or decreasing ALT (70% and 28%, p <0.001). Multivariable regression analysis showed that ΔALT>+20% was associated with increased 90-day mortality independent of other known risk factors. In conclusion, an increase in ALT in the initial phase was seen in 1/4 of patients in CS and was independently associated with 90-day mortality. This finding suggests that serial ALT measurements should be incorporated in the clinical assessment of patients in CS.
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