Incidence of hypoxic hepatitis in patients with cardiogenic shock and association with mortality

Abstract

Abstract Background Shock of any cause leads to hypoxic and toxic organ damage, especially in perfusion-sensitive organs such as the liver. In septic shock, hypoxic hepatitis is defined as an increase of ASAT and ALAT to >700 U/l and is associated with increased mortality. However, pathophysiology, dynamics and treatment differ between septic and cardiogenic shock (CS). Thus, the definition of hypoxic hepatitis derived from patients with septic shock may not be suitable in CS. Purpose To evaluate incidence and impact of hypoxic hepatitis in patients with CS based on existing as well as on novel CS-specific cut-offs. Methods Unselected patients >18 years treated for cardiogenic shock at a tertiary care centre between 2009 and 2019 were analysed for presence and prognostic impact of hypoxic hepatitis. Receiver operating curve analyses/Youden Index Method were used to determine optimal ASAT/ALAT cut-off values for hypoxic hepatitis. Multivariable adjusted logistic regressions models were constructed to compare different ASAT/ALAT cut-offs for the prediction of in-hospital mortality. Results This analysis included 698 patients [mean age 69 years, 212 (29.9%) female]. A total of 386 (55.3%) patients died. Liver enzyme elevation >700 U/l was present in 135 (19.1%) patients and not associated with in-hospital mortality (OR 1.1, 95% CI: 0.69, 1.75, p-value 0.69). Mortality was best predicted by new cut-offs with a >34% increase for ASAT and a >51% increase for ALAT. Using these criteria, hypoxic hepatitis was found in 36% (254/698 patients), most commonly during early disease trajectory (74% within first 3 days, Figure 1). Hypoxic hepatitis using this definition was associated with in-hospital mortality (OR 2.46, 95% CI: 1.67, 3.64, p-value <0.001). Conclusion Using novel, CS-specific cut-offs, defines hypoxic hepatitis as a relevant marker of excess mortality in patients with CS. These findings identify hypoxic hepatitis as a relevant disease modifier in CS and emphasises the need for further investigation of therapies reducing its occurrence and impact.Figure 1