Frequency and Prognostic Significance of Abnormal Liver Function Tests in Patients With Cardiogenic Shock
Por:
Jantti, T, Tarvasmaki, T, Harjola, VP, Parissis, J, Pulkki, K, Sionis, A, Silva-Cardoso, J, Kober, L, Banaszewski, M, Spinar, J, Fuhrmann, V, Tolonen, J, Carubelli, V, diSomma, S, Mebazaa, A, Lassus, J
Publicada:
1 oct 2017
Resumen:
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 (AALT>+20%) was observed in 24% of patients. AALT>+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 AALT>+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. (C) 2017 Elsevier Inc. All rights reserved.
Filiaciones:
Jantti, T:
Univ Helsinki, Internal Med, Helsinki, Finland
Helsinki Univ Hosp, Dept Internal Med, Helsinki, Finland
Tarvasmaki, T:
Univ Helsinki, Emergency Med, Helsinki, Finland
Helsinki Univ Hosp, Dept Emergency Med & Serv, Helsinki, Finland
Harjola, VP:
Univ Helsinki, Emergency Med, Helsinki, Finland
Helsinki Univ Hosp, Dept Emergency Med & Serv, Helsinki, Finland
Parissis, J:
Attikon Univ Hosp, Secondary Cardiol Dept, Heart Failure Clin, Athens, Greece
Pulkki, K:
Univ Eastern Finland, Dept Clin Chem, Kuopio, Finland
Eastern Finland Lab Ctr ISLAB, Kuopio, Finland
Sionis, A:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Biomed Res Inst IIB St Pau, Intens Cardiac Care Unit,Cardiol Dept, Barcelona, Spain
Silva-Cardoso, J:
Univ Porto, Porto Med Sch, Sao Joao Hosp Ctr, CINTESIS,Dept Cardiol, Oporto, Portugal
Kober, L:
Copenhagen Univ Hosp, Rigshosp, Div Heart Failure Pulm Hypertens & Heart Transpla, Copenhagen, Denmark
Banaszewski, M:
Inst Cardiol, Intens Cardiac Therapy Clin, Warsaw, Poland
Spinar, J:
Univ Hosp Brno, Dept Internal Med & Cardiol, Brno, Czech Republic
Fuhrmann, V:
Univ Med Ctr Hamburg Eppendorf, Dept Intens Care Med, Hamburg, Germany
Tolonen, J:
Univ Helsinki, Internal Med, Helsinki, Finland
Helsinki Univ Hosp, Dept Internal Med, Helsinki, Finland
Carubelli, V:
Univ & Civil Hosp Brescia, Div Cardiol, Dept Med & Surg Specialties Radiol Sci & Publ Hlt, Brescia, Italy
diSomma, S:
Univ Rome Sapienza, St Andrea Hosp, Dept Med Sci & Translat Med, Rome, Italy
Mebazaa, A:
Univ Paris Diderot, INSERM U942, Paris, France
Hop Lariboisiere, AP HP, Dept Anesthesia & Crit Care, Paris, France
Lassus, J:
Univ Helsinki, Cardiol, Helsinki, Finland
Helsinki Univ Hosp, Heart & Lung Ctr, Dept Cardiol, Helsinki, Finland
Green Published, Green Accepted
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