Hepatic Biomarker Abnormalities in the Cardiac Intensive Care Unit: Proposed Criteria for Cardiohepatic Syndrome

Liver synthetic dysfunction predicts outcomes in cardiac intensive care unit (CICU) patients.

The purpose of this study was to evaluate the associations between the severity and extent of admission liver function test (LFT) abnormalities and mortality in a mixed CICU population.

This historical cohort study included unique CICU patients from 2007 to 2018 with available data for admission LFT values. We categorized each LFT from grade 0 to grade 4 based on multiples of the upper limit of normal. We evaluated in-hospital mortality using logistic regression and 1-year mortality using Cox proportional hazards regression.

We included 7,284 patients, and 3,477 (47.7%) had at least 1 LFT with grade 1 or greater. In-hospital mortality was higher for patients with 1 or more abnormal LFTs (17.9% vs 6.4%; adjusted OR: 1.54 [95% CI: 1.27-1.86]; P < 0.001). A stepwise increase in in-hospital mortality was observed with increasing LFT grade, both overall (adjusted OR: 1.25 [95% CI: 1.16-1.34] per each higher grade; P < 0.001) and for each individual LFT. Each additional abnormal LFT was associated with higher in-hospital mortality (adjusted OR: 1.19 [95% CI: 1.10-1.29] per each; P < 0.001). One-year mortality was significantly higher in patients with abnormal LFT values (unadjusted HR: 1.70 [95% CI: 1.56-1.86]; P < 0.001) and increased incrementally as a function of the severity and extent of LFT abnormality.

The severity and extent of LFT abnormalities are positively associated with in-hospital and 1-year mortality in CICU patients. Cardiohepatic syndrome is an important predictor of prognosis in CICU patients, and inclusion of LFTs in future risk-prediction tools could enhance prognostication.