Frequency and Prognostic Significance of Abnormal Liver Function Tests in Patients With Cardiogenic Shock
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Frequency and Prognostic Significance of Abnormal Liver Function Tests in Patients With Cardiogenic Shock. / Jäntti, Toni; Tarvasmäki, Tuukka; Harjola, Veli-Pekka; Parissis, John; Pulkki, Kari; Sionis, Alessandro; Silva-Cardoso, Jose; Køber, Lars; Banaszewski, Marek; Spinar, Jindrich; Fuhrmann, Valentin; Tolonen, Jukka; Carubelli, Valentina; diSomma, Salvatore; Mebazaa, Alexandre; Lassus, Johan; CardShock investigators.
In: AM J CARDIOL, Vol. 120, No. 7, 01.10.2017, p. 1090-1097.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Frequency and Prognostic Significance of Abnormal Liver Function Tests in Patients With Cardiogenic Shock
AU - Jäntti, Toni
AU - Tarvasmäki, Tuukka
AU - Harjola, Veli-Pekka
AU - Parissis, John
AU - Pulkki, Kari
AU - Sionis, Alessandro
AU - Silva-Cardoso, Jose
AU - Køber, Lars
AU - Banaszewski, Marek
AU - Spinar, Jindrich
AU - Fuhrmann, Valentin
AU - Tolonen, Jukka
AU - Carubelli, Valentina
AU - diSomma, Salvatore
AU - Mebazaa, Alexandre
AU - Lassus, Johan
AU - CardShock investigators
N1 - Copyright © 2017 Elsevier Inc. All rights reserved.
PY - 2017/10/1
Y1 - 2017/10/1
N2 - 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.
AB - 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.
KW - Aged
KW - Alanine Transaminase
KW - Alkaline Phosphatase
KW - Europe
KW - Female
KW - Humans
KW - Incidence
KW - Liver Diseases
KW - Liver Function Tests
KW - Male
KW - Prevalence
KW - Prognosis
KW - Shock, Cardiogenic
KW - Survival Rate
KW - Journal Article
KW - Multicenter Study
KW - Observational Study
U2 - 10.1016/j.amjcard.2017.06.049
DO - 10.1016/j.amjcard.2017.06.049
M3 - SCORING: Journal article
C2 - 28821350
VL - 120
SP - 1090
EP - 1097
JO - AM J CARDIOL
JF - AM J CARDIOL
SN - 0002-9149
IS - 7
ER -
