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Incidence, laboratory detection and prognostic relevance of hypoxic hepatitis in cardiogenic shock
Christian Jung1, Georg Fuernau2,3, Ingo Eitel2,3
1Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany. christian.jung@med.uni-duesseldorf.de.
Insights
Hypoxic hepatitis (HH) is common in patients with cardiogenic shock (CS) complicating acute myocardial infarction (AMI), significantly increasing mortality risk. Aspartate aminotransferase (ASAT) is the strongest predictor of outcomes in these high-risk patients.
Area of Science:
- Cardiology
- Hepatology
- Critical Care Medicine
Background:
- Cardiogenic shock (CS) complicating acute myocardial infarction (AMI) has high mortality, with organ failure being a key determinant.
- Hypoxic hepatitis (HH) is a potential complication in CS, but its incidence and prognostic value are not well-established.
- This study aimed to investigate HH incidence, diagnostic biomarkers, and prognostic relevance in AMI-related CS.
Purpose of the Study:
- To determine the incidence of hypoxic hepatitis (HH) in patients with cardiogenic shock (CS) following acute myocardial infarction (AMI).
- To evaluate established and novel laboratory biomarkers for detecting HH in this patient population.
- To assess the prognostic significance of HH for 30-day mortality in patients with CS.
Main Methods:
- A subanalysis of 172 patients from the IABP-SHOCK II trial with CS complicating AMI was performed.
- Blood samples were analyzed for classic HH parameters and novel biomarkers (argininosuccinate synthase 1, SULT2A1).
- Thirty-day all-cause mortality was assessed as the primary outcome measure.
Main Results:
- The overall 30-day mortality rate was 40%.
- HH, defined by aminotransferase levels 20 times above normal, occurred in 18% of patients.
- Patients with HH exhibited significantly higher 30-day mortality (68% vs. 34%, p < 0.001).
- Aspartate aminotransferase (ASAT) independently predicted mortality, outperforming novel biomarkers.
- ASAT demonstrated the highest predictive accuracy for outcomes among liver markers.
Conclusions:
- Hypoxic hepatitis is a frequent complication in cardiogenic shock patients with acute myocardial infarction.
- HH is strongly associated with a poor prognosis and increased 30-day mortality.
- Aspartate aminotransferase serves as the most reliable laboratory predictor of outcome in this cohort.
Background:
Despite the improvement of therapeutic options for patients in acute myocardial infarction (AMI), cardiogenic shock (CS) remains a complication with high mortality rates. Organ failure centrally determines the prognosis of these high-risk patients. Aim of the current study was to assess the incidence of hypoxic hepatitis (HH) in CS, its laboratory detection evaluating novel and established biomarkers and to estimate the prognostic relevance of HH in current clinical practice.
Methods:
In 172 patients with CS complicating AMI, blood samples were collected at admission and after 1 day as prespecified subanalysis of the intra-aortic balloon pumping IABP-SHOCK II trial. Classic parameters of HH were measured in addition to argininosuccinate synthase 1 and sulfotransferase isoform SULT2A1 was determined as new biomarker using standard enzyme-linked immunosorbent assay kits. All-cause mortality at 30 days was used for outcome assessment.
Results:
The overall mortality rate was 40%. The incidence of HH with an increase of aminotransferase levels to be 20 times above the upper normal level was 18%. Patients with HH had a distinctly higher 30-day mortality rate compared to patients without HH (68 vs. 34%; p < 0.001). After multivariable adjustment aspartate-aminotransferase (ASAT) remained an independent predictor of 30-day mortality together with serum lactate and serum creatinine, while the new biomarkers failed to predict outcome. Comparing different liver markers using receiver operating characteristic analysis, ASAT showed the highest area under the curve for the prediction of outcome.
Conclusions:
HH occurs frequently in CS and is associated with particular poor outcome. As conventional biomarker, ASAT is the strongest laboratory predictor of outcome. ClinicalTrials.gov Identifier: NCT00491036.
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