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Interaction between Acute Hepatic Injury and Early Coagulation Dysfunction on Mortality in Patients with Acute
Yunxiang Long1, Yingmu Tong1,2, Yang Wu1
1Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China.
Insights
Acute hepatic injury worsens outcomes in acute myocardial infarction (AMI) patients, especially when combined with coagulation disorders. Early detection and management of liver injury and coagulation status are crucial for improving prognosis in AMI.
Area of Science:
- Cardiology
- Hepatology
- Critical Care Medicine
Background:
- Acute myocardial infarction (AMI) prognosis is independently affected by acute hepatic injury and complex coagulation dynamics.
- Understanding the interplay between liver function and coagulation is vital for managing AMI patients.
Purpose of the Study:
- To investigate the interaction between acute hepatic injury and coagulation dysfunction on patient outcomes in acute myocardial infarction.
- To determine if acute hepatic injury modifies the prognostic impact of coagulation disorders in AMI.
Main Methods:
- Utilized the MIMIC-III database to identify AMI patients with liver function tests within 24 hours of admission.
- Categorized patients into hepatic injury and non-hepatic injury groups based on ALT levels (>3x ULN).
- Assessed intensive care unit (ICU) mortality as the primary outcome, analyzing associations with comorbidities and coagulation status.
Main Results:
- 15.2% of AMI patients exhibited acute hepatic injury, presenting with higher comorbidity scores and more severe coagulation dysfunction.
- Acute hepatic injury significantly increased in-hospital, ICU, 28-day, and 90-day mortality, but only in patients with pre-existing coagulation disorders.
- Patients with both coagulation disorder and acute hepatic injury had substantially higher odds of ICU mortality compared to those with normal coagulation.
Conclusions:
- Early coagulation disorder appears to modulate the prognostic impact of acute hepatic injury in acute myocardial infarction patients.
- The combined presence of acute hepatic injury and coagulation dysfunction represents a critical risk factor for adverse outcomes in AMI.
- This highlights the need for integrated management strategies addressing both liver and coagulation status in AMI care.
Background:
In acute myocardial infarction (AMI), acute hepatic injury is an independent risk factor for prognosis and is associated with complex coagulation dynamics. This study aims to determine the interaction between acute hepatic injury and coagulation dysfunction on outcomes in AMI patients.
Methods:
The Medical Information Mart for Intensive Care (MIMIC-III) database was used to identify AMI patients who underwent liver function testing within 24 h of admission. After ruling out previous hepatic injury, patients were divided into the hepatic injury group and the nonhepatic injury group based on whether the alanine transaminase (ALT) level at admission was >3 times the upper limit of normal (ULN). The primary outcome was intensive care unit (ICU) mortality.
Results:
Among 703 AMI patients (67.994% male, median age 65.139 years (55.757-76.859)), acute hepatic injury occurred in 15.220% (n = 107). Compared with the nonhepatic injury group, patients with hepatic injury had a higher Elixhauser comorbidity index (ECI) score (12 (6-18) vs. 7 (1-12), p < 0.001) and more severe coagulation dysfunction (85.047% vs. 68.960%, p < 0.001). In addition, acute hepatic injury was associated with increased in-hospital mortality (odds ratio (OR) = 3.906; 95% CI: 2.053-7.433; p < 0.001), ICU mortality (OR = 4.866; 95% CI: 2.489-9.514; p < 0.001), 28-day mortality (OR = 4.129; 95% CI: 2.215-7.695; p < 0.001) and 90-day mortality (OR = 3.407; 95% CI: 1.883-6.165; p < 0.001) only in patients with coagulation disorder but not with normal coagulation. Unlike patients with coagulation disorder and normal liver, patients with both coagulation disorder and acute hepatic injury had greater odds of ICU mortality (OR = 8.565; 95% CI: 3.467-21.160; p < 0.001) than those with normal coagulation.
Conclusions:
The effects of acute hepatic injury on prognosis are likely to be modulated by early coagulation disorder in AMI patients.
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