Incidence of Hypoxic Hepatitis in Patients with Cardiogenic Shock and Association with Mortality
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Incidence of Hypoxic Hepatitis in Patients with Cardiogenic Shock and Association with Mortality. / Beer, Benedikt N; Besch, Lisa; Weimann, Jessica; Surendra, Kishore; Roedl, Kevin; Grensemann, Jörn; Sundermeyer, Jonas; Dettling, Angela; Kluge, Stefan; Kirchhof, Paulus; Blankenberg, Stefan; Scherer, Clemens; Schrage, Benedikt.
in: EUR HEART J-ACUTE CA, Jahrgang 12, Nr. 10, 25.10.2023, S. 663-670.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Incidence of Hypoxic Hepatitis in Patients with Cardiogenic Shock and Association with Mortality
AU - Beer, Benedikt N
AU - Besch, Lisa
AU - Weimann, Jessica
AU - Surendra, Kishore
AU - Roedl, Kevin
AU - Grensemann, Jörn
AU - Sundermeyer, Jonas
AU - Dettling, Angela
AU - Kluge, Stefan
AU - Kirchhof, Paulus
AU - Blankenberg, Stefan
AU - Scherer, Clemens
AU - Schrage, Benedikt
PY - 2023/10/25
Y1 - 2023/10/25
N2 - AIMS: Shock of any cause leads to end-organ damage due to ischaemia, especially in perfusion-sensitive organs such as the liver. In septic shock, hypoxic hepatitis (S-HH) is defined as the 20-fold increase of the upper normal limit of aspartate aminotransferase (ASAT) and alanine aminotransferase (ALAT) and is associated with a mortality of up to 60%. However, as pathophysiology, dynamics, and treatment differ between septic and cardiogenic shock (CS), the S-HH definition may not be suitable for CS. Therefore, we aim to evaluate if the S-HH definition is applicable in CS patients.METHODS AND RESULTS: This analysis was based on a registry of all-comer CS patients treated between 2009 and 2019 at a tertiary care centre with exclusion of minors and patients without all necessary ASAT and ALAT values. N = 698. During in-hospital follow-up, 386 (55.3%) patients died. The S-HH was not significantly associated with in-hospital mortality in CS patients. To define HH among patients with CS (C-HH), optimal cut-off values were found to be ≥1.34-fold increase for ASAT and ≥1.51-fold increase for ALAT in serial measurements. The incidence of C-HH was 254/698 patients (36%) and C-HH showed a strong association with in-hospital mortality (odds ratio 2.36, 95% confidence interval: 1.61, 3.49).CONCLUSION: The C-HH is a frequent and relevant comorbidity in patients with CS, although its definition varies from the established definition of HH in patients with septic shock. As C-HH contributed to excess mortality risk, these findings emphasize the need for further investigation of therapies reducing the occurrence of C-HH and also improving the associated outcome.
AB - AIMS: Shock of any cause leads to end-organ damage due to ischaemia, especially in perfusion-sensitive organs such as the liver. In septic shock, hypoxic hepatitis (S-HH) is defined as the 20-fold increase of the upper normal limit of aspartate aminotransferase (ASAT) and alanine aminotransferase (ALAT) and is associated with a mortality of up to 60%. However, as pathophysiology, dynamics, and treatment differ between septic and cardiogenic shock (CS), the S-HH definition may not be suitable for CS. Therefore, we aim to evaluate if the S-HH definition is applicable in CS patients.METHODS AND RESULTS: This analysis was based on a registry of all-comer CS patients treated between 2009 and 2019 at a tertiary care centre with exclusion of minors and patients without all necessary ASAT and ALAT values. N = 698. During in-hospital follow-up, 386 (55.3%) patients died. The S-HH was not significantly associated with in-hospital mortality in CS patients. To define HH among patients with CS (C-HH), optimal cut-off values were found to be ≥1.34-fold increase for ASAT and ≥1.51-fold increase for ALAT in serial measurements. The incidence of C-HH was 254/698 patients (36%) and C-HH showed a strong association with in-hospital mortality (odds ratio 2.36, 95% confidence interval: 1.61, 3.49).CONCLUSION: The C-HH is a frequent and relevant comorbidity in patients with CS, although its definition varies from the established definition of HH in patients with septic shock. As C-HH contributed to excess mortality risk, these findings emphasize the need for further investigation of therapies reducing the occurrence of C-HH and also improving the associated outcome.
U2 - 10.1093/ehjacc/zuad076
DO - 10.1093/ehjacc/zuad076
M3 - SCORING: Journal article
C2 - 37410589
VL - 12
SP - 663
EP - 670
JO - EUR HEART J-ACUTE CA
JF - EUR HEART J-ACUTE CA
SN - 2048-8726
IS - 10
ER -