Abstract
To investigate whether acute liver failure (ALF) leads to secondary acute myocardial injury, 100 ALF patients that were retrospectively identified in a single center based on ICD 10 codes and 8 rats from an experimental study that died early after bile duct ligation (BDL) were examined. Creatine kinase (CK), creatine kinase-MB isoenzyme (CKMB) and cardiac troponin-I (cTnI) were analyzed as markers of myocardial injury. For histological analysis, hematoxylin-eosin (HE), elastic Van Gieson (EVG), CD41 and myeloperoxidase were used to stain rat hearts. Major adverse cardiac events (MACEs) were a critical factor for mortality (p = 0.037) in human ALF. Deceased patients exhibited higher levels of CKMB than survivors (p = 0.023). CKMB was a predictor of mortality in ALF (p = 0.013). Animals that died early after BDL exhibited increased cTnI, CKMB, tumor necrosis factor α (TNFα) and interleukin-6 (IL-6) levels compared to controls (cTnI: p = 0.011, CKMB: p = 0.008, TNFα: p = 0.003, IL-6: p = 0.006). These animals showed perivascular lesions and wavy fibers, microthrombi and neutrophilic infiltration in the heart. MACEs are decisive for mortality in human ALF, and elevated CKMB values indicate that this might be due to structural myocardial damage. Accordingly, CKMB was found to have predictive value for mortality in ALF. The results are substantiated by data from a rat BDL model demonstrating diffuse myocardial injury.
Highlights
Acute liver failure (ALF), with an approximate annual incidence of 5.5 cases per million inhabitants, is a rather rare disease, but with a mortality rate of 40%, it is still life-threatening [1]
Our present analysis has shown that there has been a 49% increase in cardiospecific diagnoses in patients with ALF during their stay in the hospital and that the occurrence of Major adverse cardiac events (MACEs) is a critical factor for mortality that is almost as important as sepsis (MACE: p = 0.037 vs. sepsis p = 0.002 Table 3)
creatine kinase-MB isoenzyme (CKMB) was identified as an independent predictor of mortality in ALF (p = 0.013), showing a positive predictive value of 66.7% and a negative predictive value of 91.4% for CKMB values above 112 μg/L (Fig 2B)
Summary
Acute liver failure (ALF), with an approximate annual incidence of 5.5 cases per million inhabitants, is a rather rare disease, but with a mortality rate of 40%, it is still life-threatening [1]. It is the result of severe hepatocellular injury due to a variety of triggers, such as acetaminophen intoxication or viral hepatitis, to name just two of the most prevalent examples. Acute myocardial injury secondary to severe acute liver failure
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
