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Prognostic Impacts of Increases in Amino Transaminases Following Coronary Artery Bypass Grafting on Mortality
Ji-Hyun Chin1, Jun-Young Jo1, Eun-Ho Lee1
1Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Insights
Postoperative increases in aspartate amino transaminase (AST) and alanine amino transaminase (ALT) predict 1-year mortality after coronary artery bypass graft (CABG) surgery. Elevated AST or both AST and ALT above twice the normal limit indicate higher mortality risk.
Area of Science:
- Cardiology
- Hepatology
- Surgical Outcomes
Background:
- Coronary artery bypass graft (CABG) surgery is a major cardiovascular procedure.
- Postoperative liver enzyme elevations can occur, but their prognostic significance is not fully understood.
Purpose of the Study:
- To investigate the association between postoperative serum amino transaminase levels and 1-year mortality in CABG patients.
- To determine if specific enzyme elevation patterns predict adverse outcomes.
Main Methods:
- Retrospective analysis of 1,950 patients undergoing CABG at a tertiary care university hospital.
- Calculation of aspartate amino transaminase (AST) and alanine amino transaminase (ALT) ratios based on peak levels within 5 days post-surgery relative to upper limit of normal.
- Statistical analysis using univariate and multivariable models to assess the impact on 1-year mortality.
Main Results:
- An AST ratio > 2.0 was associated with increased 1-year mortality (HR 2.68, P=0.002).
- Combined AST and ALT ratios > 2.0 showed a stronger association with increased 1-year mortality (HR 3.90, P<0.001).
- Isolated increases in ALT above the normal limit were not linked to higher mortality.
Conclusions:
- Postoperative AST elevation, particularly when > 2.0 times the upper limit of normal, is a significant predictor of 1-year mortality post-CABG.
- Concurrent elevations in both AST and ALT above this threshold further increase mortality risk.
- ALT elevation alone does not appear to be a significant prognostic indicator for 1-year mortality in this patient cohort.
Objective:
To evaluate the prognostic impacts of postoperative increases in serum amino transaminases on 1-year mortality in patients who underwent coronary artery bypass graft.
Design:
A retrospective analysis.
Setting:
A tertiary care university hospital.
Participants:
A total of 1,950 patients who underwent coronary artery bypass graft.
Interventions:
None.
Measurements And Main Results:
Aspartate amino transaminase and alanine amino transaminase ratios were calculated as the ratio between the peak aspartate amino transaminase and alanine amino transaminase within the first 5 post-operative days and their respective upper limit of normal values. A ratio of 2.0 was seen to be the minimum for which a difference in 1-year mortality could be detected in univariate analysis, when considering simultaneously both aspartate amino transaminase and alanine amino transaminase ratios. Multivariable analysis showed an association between an aspartate amino transaminase ratio > 2.0 and increased 1-year mortality (hazard ratio [HR] 2.68, 95% confidence interval [CI] 1.42-5.05, P = 0.002), and also between both an aspartate amino transaminase and alanine amino transaminase ratio > 2.0 and increased 1-year mortality (HR 3.90, 95% CI 1.87-8.14, P < 0.001). However, increases in alanine amino transaminase only above the upper limit of normal were not associated with increased 1-year mortality.
Conclusions:
Postoperative increases in aspartate amino transaminase only and increases in both aspartate amino transaminase and alanine amino transaminase greater than twice the upper limit of normal were associated with increased 1-year mortality in patients undergoing coronary artery bypass graft.