Postoperatively Increased Serum Alanine Aminotransferase Level Is Closely Associated with Mortality after Cardiac Surgery
19 May 2014
31 July 2014
31 October 2014 (eFirst)
Background Hepatic biomarkers are often not assessed routinely after cardiac surgery. Alanine aminotransferase (ALT) has become the primary biomarker of any type of liver injury. Our purpose was to study the prognostic value of serum ALT in early and late mortality.
Methods Patients subjected to any type of cardiac operation from January 1999 through December 2010 were studied. According to postoperative maximum ALT level, four groups were created: group 1 = ALT ≤ 50 U/L (n = 8,669), group 2 = ALT 50 to 150 U/L (n = 3,055), group 3 = ALT 151 to 500 U/L (n = 248), and group 4 = ALT > 500 U/L (n = 50). Cox multivariate modeling was used for survival analysis.
Results Patients in groups 3 and 4 had increased 30-day mortality (hazard ratio [HR] = 8.07 [4.15–15.69], p < 0.001 and HR = 19.07 [9.88–36.80], p < 0.001, respectively). Late mortality was increased for group 4 after final adjustments (HR = 1.87 [1.18–2.95], p = 0.007).
Conclusion Elevated postoperative ALT level (above 150 U/L) is closely associated with early mortality after cardiac surgery. ALT level above 500 U/L implies a substantial liver dysfunction with a considerable negative association on both early and late survival.
- 1 Senior JR. Alanine aminotransferase: a clinical and regulatory tool for detecting liver injury-past, present, and future. Clin Pharmacol Ther 2012; 92 (3) 332-339
- 2 Raman JS, Kochi K, Morimatsu H, Buxton B, Bellomo R. Severe ischemic early liver injury after cardiac surgery. Ann Thorac Surg 2002; 74 (5) 1601-1606
- 3 Shteyer E, Yatsiv I, Sharkia M, Milgarter E, Granot E. Serum transaminases as a prognostic factor in children post cardiac surgery. Pediatr Int 2011; 53 (5) 725-728
- 4 Paparella D, Yau TM, Young E. Cardiopulmonary bypass induced inflammation: pathophysiology and treatment. An update. Eur J Cardiothorac Surg 2002; 21 (2) 232-244
- 5 Shen Z, Wang Z, Zhang J, Jing H. Hepatic injury in a rat cardiopulmonary bypass model. Interact Cardiovasc Thorac Surg 2008; 7 (1) 18-22
- 6 Yamada T, Ochiai R, Takeda J, Kikuchi H, Ishibashi M, Watanabe K. Off-pump coronary artery bypass attenuates transient hepatocellular damage after myocardial revascularization. J Cardiothorac Vasc Anesth 2005; 19 (5) 603-607
- 7 Mastoraki A, Karatzis E, Mastoraki S, Kriaras I, Sfirakis P, Geroulanos S. Postoperative jaundice after cardiac surgery. Hepatobiliary Pancreat Dis Int 2007; 6 (4) 383-387
- 8 van Boxtel AGM, Bramer S, Soliman Hamad MA, van Straten AHM. Perioperative serum aspartate aminotransferase level as a predictor of survival after coronary artery bypass grafting. Ann Thorac Surg 2012; 94 (5) 1492-1498
- 9 Steuer J, Hörte LG, Lindahl B, Ståhle E. Impact of perioperative myocardial injury on early and long-term outcome after coronary artery bypass grafting. Eur Heart J 2002; 23 (15) 1219-1227