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Frequency and Prognostic Significance of Abnormal Liver Function Tests in Patients With Cardiogenic Shock
T. Jäntti, T. Tarvasmäki, VP. Harjola, J. Parissis, K. Pulkki, A. Sionis, J. Silva-Cardoso, L. Køber, M. Banaszewski, J. Spinar, V. Fuhrmann, J. Tolonen, V. Carubelli, S. diSomma, A. Mebazaa, J. Lassus, . ,
Language English Country United States
Document type Journal Article, Multicenter Study, Observational Study
NLK
ProQuest Central
from 2012-08-15 to 2 months ago
Nursing & Allied Health Database (ProQuest)
from 2012-08-15 to 2 months ago
Health & Medicine (ProQuest)
from 2012-08-15 to 2 months ago
- MeSH
- Alanine Transaminase blood MeSH
- Alkaline Phosphatase blood MeSH
- Incidence MeSH
- Liver Function Tests statistics & numerical data MeSH
- Shock, Cardiogenic blood complications mortality MeSH
- Humans MeSH
- Survival Rate MeSH
- Liver Diseases diagnosis epidemiology etiology MeSH
- Prevalence MeSH
- Prognosis MeSH
- Aged MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Observational Study MeSH
- Geographicals
- Europe epidemiology MeSH
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.
Department of Anesthesia and Critical Care Hôpital Lariboisière APHP Paris France
Department of Intensive Care Medicine University Medical Center Hamburg Eppendorf Hamburg Germany
Department of Internal Medicine and Cardiology University Hospital Brno Brno Czech Republic
Heart Failure Clinic Secondary Cardiology Department Attikon University Hospital Athens Greece
INSERM U942 University Paris Diderot Paris France
Intensive Cardiac Therapy Clinic Institute of Cardiology Warsaw Poland
References provided by Crossref.org
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- $a Jäntti, Toni $u Internal Medicine, University of Helsinki and Department of Internal Medicine, Helsinki University Hospital, Helsinki, Finland. Electronic address: toni.jantti@fimnet.fi.
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- $a 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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