The Relationship Between Changes in Liver Enzymes and Mortality of Patients Admitted to a Surgical Intensive Care Unit
Archives of Critical Care Medicine,
Vol. 2 No. 1 (2016),
30 October 2023
Abstract
Background: Increased levels of alanine transaminase (ALT) and alkaline phosphatase in the liver are associated with an increased risk of mortality in hospitalized patients. This study aimed to survey the relationship between changes in liver enzymes and mor[1]tality of patients admitted to a surgical intensive care unit (ICU).
Methods: This cross sectional study was based on the electronic and clinical records of patients, hospitalized in the ICU of Rasool Akram hospital from 2012 to 2015. The information of 199 alive and 140 deceased patients was studied. The laboratory parameters, clinical information, acute physiology and chronic health evaluation (APACHE-II) scores, and sequential organ failure assessment (SOFA) scores were determined upon admission, and length of ICU stay was measured.
Results: There was a significant difference in the aspartate aminotransferase (AST) level upon admission in alive and deceased groups (42.01 ± 46.65 and 58.54 ± 80.95 mg/dL, respectively) (P < 0.05). However, there was no significant difference in the level of AST at discharge between the groups (39.05±36.69 and 67.95±21.7mg/dL, respectively) (P > 0.05). There was a significant difference in the level of ALT upon admission between the groups (34.21±58.13 and 41.32±66.77mg/dL, respectively) (P > 0.05). However, there was no significant difference in ALT level at discharge between the groups (38.44 ± 48.69 and 42.94 ± 76.47 mg/dL, respectively) (P > 0.05). Based on the multivariate logistic regression model, the predictive factors for mortality included use of inotropes, alkaline phosphatase, and reduced platelet count, potassium level, and heart rate.
Conclusions: Measurement of serum liver enzymes has inadequate predictive value for mortality in ICU patients
- Intensive Care Units
- Liver Enzyme
- Mortality
How to Cite
References
Lee WM. Drug-induced hepatotoxicity. N Engl J Med. 2003;349(5):474–
doi: 10.1056/NEJMra021844. [PubMed: 12890847].
Thomson SJ, Cowan ML, Johnston I, Musa S, Grounds M, Rahman
TM. ’Liver function tests’ on the intensive care unit: a prospective, observational study. Intensive Care Med. 2009;35(8):1406–11. doi:
1007/s00134-009-1511-7. [PubMed: 19513695].
Dancygier H. Clinical hepatology: Principles and practice of hepatobiliary
diseases. 2. Springer Science & Business Media; 2009.
Field E, Horst HM, Rubinfeld IS, Copeland CF, Waheed U, Jordan J, et
al. Hyperbilirubinemia: a risk factor for infection in the surgical intensive care unit. Am J Surg. 2008;195(3):304–6. discussion 306-7. doi:
1016/j.amjsurg.2007.12.010. [PubMed: 18206848].
Brienza N, Dalfino L, Cinnella G, Diele C, Bruno F, Fiore T. Jaundice in critical illness: promoting factors of a concealed reality. Intensive Care Med. 2006;32(2):267–74. doi: 10.1007/s00134-005-0023-3.
[PubMed: 16450099].
Kramer L, Jordan B, Druml W, Bauer P, Metnitz PG, Austrian Epidemiologic Study on Intensive Care ASG. Incidence and prognosis of early hepatic dysfunction in critically ill patients–a prospective multicenter study. Crit Care Med. 2007;35(4):1099–104. doi:
1097/01.CCM.0000259462.97164.A0. [PubMed: 17334250].
Mesotten D, Wauters J, Van den Berghe G, Wouters PJ, Milants I,
Wilmer A. The effect of strict blood glucose control on biliary sludge
and cholestasis in critically ill patients. J Clin Endocrinol Metab.
;94(7):2345–52. doi: 10.1210/jc.2008-2579. [PubMed: 19366849].
Harbrecht BG, Doyle HR, Clancy KD, Townsend RN, Billiar TR, Peitzman
AB. The impact of liver dysfunction on outcome in patients with multiple injuries. Am Surg. 2001;67(2):122–6. [PubMed: 11243533].
Wiegand BD, Ketterer SG, Rapaport E. The use of indocyanine green
for the evaluation of hepatic function and blood flow in man. Am J
Dig Dis. 1960;5:427–36. [PubMed: 13844597].
Sakka SG, Reinhart K, Meier-Hellmann A. Prognostic value of the indocyanine green plasma disappearance rate in critically ill patients.
Chest. 2002;122(5):1715–20. [PubMed: 12426276].
Kimura S, Yoshioka T, Shibuya M, Sakano T, Tanaka R, Matsuyama S.
Indocyanine green elimination rate detects hepatocellular dysfunction early in septic shock and correlates with survival. Crit Care Med.
;29(6):1159–63. [PubMed: 11395594].
Koch A, Horn A, Duckers H, Yagmur E, Sanson E, Bruensing J, et al.
Increased liver stiffness denotes hepatic dysfunction and mortality
risk in critically ill non-cirrhotic patients at a medical ICU. Crit Care.
;15(6):R266. doi: 10.1186/cc10543. [PubMed: 22082207].
Henrion J, Schapira M, Luwaert R, Colin L, Delannoy A, Heller
FR. Hypoxic hepatitis: clinical and hemodynamic study in 142
consecutive cases. Medicine (Baltimore). 2003;82(6):392–406. doi:
1097/01.md.0000101573.54295.bd. [PubMed: 14663289].
Raurich JM, Perez O, Llompart-Pou JA, Ibanez J, Ayestaran I, PerezBarcena J. Incidence and outcome of ischemic hepatitis complicating septic shock. Hepatol Res. 2009;39(7):700–5. doi: 10.1111/j.1872-
X.2009.00501.x. [PubMed: 19473435].
Fuhrmann V, Kneidinger N, Herkner H, Heinz G, Nikfardjam M, Bojic A, et al. Impact of hypoxic hepatitis on mortality in the intensive
care unit. Intensive Care Med. 2011;37(8):1302–10. doi: 10.1007/s00134-
-2248-7. [PubMed: 21647720].
Pastor CM, Suter PM. Hepatic hemodynamics and cell functions in
human and experimental sepsis. Anesth Analg. 1999;89(2):344–52.
[PubMed: 10439746].
Geier A, Fickert P, Trauner M. Mechanisms of disease: mechanisms
and clinical implications of cholestasis in sepsis. Nat Clin Pract Gastroenterol Hepatol. 2006;3(10):574–85. doi: 10.1038/ncpgasthep0602.
[PubMed: 17008927].
Kortgen A, Paxian M, Werth M, Recknagel P, Rauchfuss F, Lupp A,
et al. Prospective assessment of hepatic function and mechanisms
of dysfunction in the critically ill. Shock. 2009;32(4):358–65. doi:
1097/SHK.0b013e31819d8204. [PubMed: 19197231].
Larrey D. Epidemiology and individual susceptibility to adverse drug
reactions affecting the liver. Semin Liver Dis. 2002;22(2):145–55. doi:
1055/s-2002-30105. [PubMed: 12016546].
Lat I, Foster DR, Erstad B. Drug-induced acute liver failure and gastrointestinal complications. Crit Care Med. 2010;38(6 Suppl):S175–87.
doi: 10.1097/CCM.0b013e3181de0db2. [PubMed: 20502172].
Navarro VJ, Senior JR. Drug-related hepatotoxicity. N Engl J Med.
;354(7):731–9. doi: 10.1056/NEJMra052270. [PubMed: 16481640].
Fontana RJ, Watkins PB, Bonkovsky HL, Chalasani N, Davern T, Serrano J, et al. Drug-Induced Liver Injury Network (DILIN) prospective
study: rationale, design and conduct. Drug Saf. 2009;32(1):55–68. doi:
2165/00002018-200932010-00005. [PubMed: 19132805].
Bernal W, Auzinger G, Dhawan A, Wendon J. Acute liver failure. Lancet.
;376(9736):190–201. doi: 10.1016/S0140-6736(10)60274-7. [PubMed:
.
Mindikoglu AL, Magder LS, Regev A. Outcome of liver transplantation for drug-induced acute liver failure in the United States: analysis of the United Network for Organ Sharing database. Liver Transpl.
;15(7):719–29. doi: 10.1002/lt.21692. [PubMed: 19562705].
Carter BA, Shulman RJ. Mechanisms of disease: update on the molecular etiology and fundamentals of parenteral nutrition associated
cholestasis. Nat Clin Pract Gastroenterol Hepatol. 2007;4(5):277–87. doi:
1038/ncpgasthep0796. [PubMed: 17476210].
Grau T, Bonet A, Rubio M, Mateo D, Farre M, Acosta JA, et al. Liver dysfunction associated with artificial nutrition in critically ill patients.
Crit Care. 2007;11(1):R10. doi: 10.1186/cc5670. [PubMed: 17254321].
Sy E, Ronco JJ, Searle R, Karvellas CJ. Prognostication of critically ill
patients with acute-on-chronic liver failure using the Chronic Liver
Failure-Sequential Organ Failure Assessment: A Canadian retrospective study. J Crit Care. 2016;36:234–9. doi: 10.1016/j.jcrc.2016.08.003.
[PubMed: 27569253].
Ambrosy AP, Gheorghiade M, Bubenek S, Vinereanu D, Vaduganathan
M, Macarie C, et al. The predictive value of transaminases at admission in patients hospitalized for heart failure: findings from the ROAHFS registry. Eur Heart J Acute Cardiovasc Care. 2013;2(2):99–108. doi:
1177/2048872612474906. [PubMed: 24222818].
Yeo CD, Kim JW, Kim SC, Kim YK, Kim KH, Kim HJ, et al. Prognostic
factors in critically ill patients with hematologic malignancies admitted to the intensive care unit. J Crit Care. 2012;27(6):739 e1–6. doi:
1016/j.jcrc.2012.07.014. [PubMed: 23217573].
Shteyer E, Yatsiv I, Sharkia M, Milgarter E, Granot E. Serum transaminases as a prognostic factor in children post cardiac surgery. Pediatr Int. 2011;53(5):725–8. doi: 10.1111/j.1442-200X.2011.03356.x. [PubMed:
.
Raurich JM, Llompart-Pou JA, Ferreruela M, Colomar A, Molina M,
Royo C, et al. Hypoxic hepatitis in critically ill patients: incidence,
etiology and risk factors for mortality. J Anesth. 2011;25(1):50–6. doi:
1007/s00540-010-1058-3. [PubMed: 21153035].
Lazzeri C, Valente S, Tarquini R, Chiostri M, Picariello C, Gensini GF.
Prognostic values of admission transaminases in ST-elevation myocardial infarction submitted to primary angioplasty. Med Sci Monit.
;16(12):CR567–74. [PubMed: 21119573]
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