Frequency and Prognostic Significance of Abnormal Liver Function Tests in Patients With Cardiogenic Shock

Toni Jäntti; Tuukka Tarvasmäki; Veli Pekka Harjola; John Parissis; Kari Pulkki; Alessandro Sionis; Jose Silva-Cardoso; Lars Køber; Marek Banaszewski; Jindrich Spinar; Valentin Fuhrmann; Jukka Tolonen; Valentina Carubelli; Salvatore diSomma; Alexandre Mebazaa; Johan Lassus; CardShock investigators; Katerina Koniari; Astrinos Voumvourakis; Apostolos Karavidas; Jordi Sans-Rosello; Montserrat Vila; Albert Duran-Cambra; Marco Metra; Michela Bulgari; Valentina Lazzarini; Jiri Parenica; Roman Stipal; Ondrej Ludka; Marie Palsuva; Eva Ganovska; Petr Kubena; Matias G. Lindholm; Christian Hassager; Tom Bäcklund; Raija Jurkko; Kristiina Järvinen; Tuomo Nieminen; Kari Pulkki; Leena Soininen; Reijo Sund; Ilkka Tierala; Marjut Varpula; Tuomas Korva; Jukka Tolonen; Anne Pitkälä; Rossella Marino; Alexandra Sousa; Carla Sousa; Mariana Paiva; Inês Rangel; Rui Almeida; Teresa Pinho; Maria Júlia Maciel; Janina Stepinska; Anna Skrobisz; Piotr Góral

doi:10.1016/j.amjcard.2017.06.049

Frequency and Prognostic Significance of Abnormal Liver Function Tests in Patients With Cardiogenic Shock

Toni Jäntti^*, Tuukka Tarvasmäki, Veli Pekka Harjola, John Parissis, Kari Pulkki, Alessandro Sionis, Jose Silva-Cardoso, Lars Køber, Marek Banaszewski, Jindrich Spinar, Valentin Fuhrmann, Jukka Tolonen, Valentina Carubelli, Salvatore diSomma, Alexandre Mebazaa, Johan Lassus, CardShock investigators, Katerina Koniari, Astrinos Voumvourakis, Apostolos KaravidasJordi Sans-Rosello, Montserrat Vila, Albert Duran-Cambra, Marco Metra, Michela Bulgari, Valentina Lazzarini, Jiri Parenica, Roman Stipal, Ondrej Ludka, Marie Palsuva, Eva Ganovska, Petr Kubena, Matias G. Lindholm, Christian Hassager, Tom Bäcklund, Raija Jurkko, Kristiina Järvinen, Tuomo Nieminen, Kari Pulkki, Leena Soininen, Reijo Sund, Ilkka Tierala, Marjut Varpula, Tuomas Korva, Jukka Tolonen, Anne Pitkälä, Rossella Marino, Alexandra Sousa, Carla Sousa, Mariana Paiva, Inês Rangel, Rui Almeida, Teresa Pinho, Maria Júlia Maciel, Janina Stepinska, Anna Skrobisz, Piotr Góral

^*Corresponding author for this work

Department of Clinical Medicine

9 Citations (Scopus)

Abstract

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.

Original language	English
Journal	American Journal of Cardiology
Volume	120
Issue number	7
Pages (from-to)	1090-1097
Number of pages	8
ISSN	0002-9149
DOIs	https://doi.org/10.1016/j.amjcard.2017.06.049
Publication status	Published - Oct 2017

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Jäntti, T., Tarvasmäki, T., Harjola, V. P., Parissis, J., Pulkki, K., Sionis, A., Silva-Cardoso, J., Køber, L., Banaszewski, M., Spinar, J., Fuhrmann, V., Tolonen, J., Carubelli, V., diSomma, S., Mebazaa, A., Lassus, J., CardShock investigators, Koniari, K., Voumvourakis, A., ... Góral, P. (2017). Frequency and Prognostic Significance of Abnormal Liver Function Tests in Patients With Cardiogenic Shock. American Journal of Cardiology, 120(7), 1090-1097. https://doi.org/10.1016/j.amjcard.2017.06.049

Jäntti, T, Tarvasmäki, T, Harjola, VP, Parissis, J, Pulkki, K, Sionis, A, Silva-Cardoso, J, Køber, L, Banaszewski, M, Spinar, J, Fuhrmann, V, Tolonen, J, Carubelli, V, diSomma, S, Mebazaa, A, Lassus, J, CardShock investigators, Koniari, K, Voumvourakis, A, Karavidas, A, Sans-Rosello, J, Vila, M, Duran-Cambra, A, Metra, M, Bulgari, M, Lazzarini, V, Parenica, J, Stipal, R, Ludka, O, Palsuva, M, Ganovska, E, Kubena, P, Lindholm, MG, Hassager, C, Bäcklund, T, Jurkko, R, Järvinen, K, Nieminen, T, Pulkki, K, Soininen, L, Sund, R, Tierala, I, Varpula, M, Korva, T, Tolonen, J, Pitkälä, A, Marino, R, Sousa, A, Sousa, C, Paiva, M, Rangel, I, Almeida, R, Pinho, T, Maciel, MJ, Stepinska, J, Skrobisz, A & Góral, P 2017, 'Frequency and Prognostic Significance of Abnormal Liver Function Tests in Patients With Cardiogenic Shock', American Journal of Cardiology, vol. 120, no. 7, pp. 1090-1097. https://doi.org/10.1016/j.amjcard.2017.06.049

@article{a44fbec8431f48f8b2e7ec6cbaf20a17,

title = "Frequency and Prognostic Significance of Abnormal Liver Function Tests in Patients With Cardiogenic Shock",

abstract = "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.",

author = "Toni J{\"a}ntti and Tuukka Tarvasm{\"a}ki and Harjola, {Veli Pekka} and John Parissis and Kari Pulkki and Alessandro Sionis and Jose Silva-Cardoso and Lars K{\o}ber and Marek Banaszewski and Jindrich Spinar and Valentin Fuhrmann and Jukka Tolonen and Valentina Carubelli and Salvatore diSomma and Alexandre Mebazaa and Johan Lassus and {CardShock investigators} and Katerina Koniari and Astrinos Voumvourakis and Apostolos Karavidas and Jordi Sans-Rosello and Montserrat Vila and Albert Duran-Cambra and Marco Metra and Michela Bulgari and Valentina Lazzarini and Jiri Parenica and Roman Stipal and Ondrej Ludka and Marie Palsuva and Eva Ganovska and Petr Kubena and Lindholm, {Matias G.} and Christian Hassager and Tom B{\"a}cklund and Raija Jurkko and Kristiina J{\"a}rvinen and Tuomo Nieminen and Kari Pulkki and Leena Soininen and Reijo Sund and Ilkka Tierala and Marjut Varpula and Tuomas Korva and Jukka Tolonen and Anne Pitk{\"a}l{\"a} and Rossella Marino and Alexandra Sousa and Carla Sousa and Mariana Paiva and In{\^e}s Rangel and Rui Almeida and Teresa Pinho and Maciel, {Maria J{\'u}lia} and Janina Stepinska and Anna Skrobisz and Piotr G{\'o}ral",

year = "2017",

month = oct,

doi = "10.1016/j.amjcard.2017.06.049",

language = "English",

volume = "120",

pages = "1090--1097",

journal = "Am. J. Cardiol.",

issn = "0002-9149",

publisher = "Elsevier",

number = "7",

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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

AU - Koniari, Katerina

AU - Voumvourakis, Astrinos

AU - Karavidas, Apostolos

AU - Sans-Rosello, Jordi

AU - Vila, Montserrat

AU - Duran-Cambra, Albert

AU - Metra, Marco

AU - Bulgari, Michela

AU - Lazzarini, Valentina

AU - Parenica, Jiri

AU - Stipal, Roman

AU - Ludka, Ondrej

AU - Palsuva, Marie

AU - Ganovska, Eva

AU - Kubena, Petr

AU - Lindholm, Matias G.

AU - Hassager, Christian

AU - Bäcklund, Tom

AU - Jurkko, Raija

AU - Järvinen, Kristiina

AU - Nieminen, Tuomo

AU - Pulkki, Kari

AU - Soininen, Leena

AU - Sund, Reijo

AU - Tierala, Ilkka

AU - Varpula, Marjut

AU - Korva, Tuomas

AU - Tolonen, Jukka

AU - Pitkälä, Anne

AU - Marino, Rossella

AU - Sousa, Alexandra

AU - Sousa, Carla

AU - Paiva, Mariana

AU - Rangel, Inês

AU - Almeida, Rui

AU - Pinho, Teresa

AU - Maciel, Maria Júlia

AU - Stepinska, Janina

AU - Skrobisz, Anna

AU - Góral, Piotr

PY - 2017/10

Y1 - 2017/10

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.

U2 - 10.1016/j.amjcard.2017.06.049

DO - 10.1016/j.amjcard.2017.06.049

M3 - Journal article

C2 - 28821350

AN - SCOPUS:85027444530

SN - 0002-9149

VL - 120

SP - 1090

EP - 1097

JO - Am. J. Cardiol.

JF - Am. J. Cardiol.

IS - 7

ER -

Frequency and Prognostic Significance of Abnormal Liver Function Tests in Patients With Cardiogenic Shock

Abstract

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