Acute liver dysfunction after cardiac arrest.
Few data are available regarding hypoxic hepatitis (HH) and acute liver failure (ALF) in patients resuscitated from cardiac arrest (CA). The aim of this study was to describe the occurrence of these complications and their association with outcome. All adult patients admitted to the Department of In...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2018-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC6218055?pdf=render |
| _version_ | 1819042815478333440 |
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| author | Enrica Iesu Federico Franchi Federica Zama Cavicchi Selene Pozzebon Vito Fontana Manuel Mendoza Leda Nobile Sabino Scolletta Jean-Louis Vincent Jacques Creteur Fabio Silvio Taccone |
| author_facet | Enrica Iesu Federico Franchi Federica Zama Cavicchi Selene Pozzebon Vito Fontana Manuel Mendoza Leda Nobile Sabino Scolletta Jean-Louis Vincent Jacques Creteur Fabio Silvio Taccone |
| author_sort | Enrica Iesu |
| collection | DOAJ |
| description | Few data are available regarding hypoxic hepatitis (HH) and acute liver failure (ALF) in patients resuscitated from cardiac arrest (CA). The aim of this study was to describe the occurrence of these complications and their association with outcome. All adult patients admitted to the Department of Intensive Care following CA were considered for inclusion in this retrospective study. Exclusion criteria were early death (<24 hours) or missing biological data. We retrieved data concerning CA characteristics and markers of liver function. ALF was defined as a bilirubin >1.2 mg/dL and an international normalized ratio ≥1.5. HH was defined as an aminotransferase level >1000 IU/L. Neurological outcome was assessed at 3 months and an unfavourable neurological outcome was defined as a Cerebral Performance Categories (CPC) score of 3-5. A total of 374 patients (age 62 [52-74] years; 242 male) were included. ALF developed in 208 patients (56%) and HH in 27 (7%); 24 patients developed both conditions. Patients with HH had higher mortality (89% vs. 51% vs. 45%, respectively) and greater rates of unfavourable neurological outcome (93% vs. 60% vs. 59%, respectively) compared to those with ALF without HH (n = 184) and those without ALF or HH (n = 163; p = 0.03). Unwitnessed arrest, non-shockable initial rhythm, lack of bystander cardiopulmonary resuscitation, high adrenaline doses and the development of acute kidney injury were independent predictors of unfavourable neurological outcome; HH (OR: 16.276 [95% CIs: 2.625-81.345; p = 0.003), but not ALF, was also a significant risk-factor for unfavourable outcome. Although ALF occurs frequently after CA, HH is a rare complication. Only HH is significantly associated with poor neurological outcome in this setting. |
| first_indexed | 2024-12-21T09:46:53Z |
| format | Article |
| id | doaj.art-47f314bb8aea41aaaf82c13c4e77a605 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-21T09:46:53Z |
| publishDate | 2018-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-47f314bb8aea41aaaf82c13c4e77a6052022-12-21T19:08:19ZengPublic Library of Science (PLoS)PLoS ONE1932-62032018-01-011311e020665510.1371/journal.pone.0206655Acute liver dysfunction after cardiac arrest.Enrica IesuFederico FranchiFederica Zama CavicchiSelene PozzebonVito FontanaManuel MendozaLeda NobileSabino ScollettaJean-Louis VincentJacques CreteurFabio Silvio TacconeFew data are available regarding hypoxic hepatitis (HH) and acute liver failure (ALF) in patients resuscitated from cardiac arrest (CA). The aim of this study was to describe the occurrence of these complications and their association with outcome. All adult patients admitted to the Department of Intensive Care following CA were considered for inclusion in this retrospective study. Exclusion criteria were early death (<24 hours) or missing biological data. We retrieved data concerning CA characteristics and markers of liver function. ALF was defined as a bilirubin >1.2 mg/dL and an international normalized ratio ≥1.5. HH was defined as an aminotransferase level >1000 IU/L. Neurological outcome was assessed at 3 months and an unfavourable neurological outcome was defined as a Cerebral Performance Categories (CPC) score of 3-5. A total of 374 patients (age 62 [52-74] years; 242 male) were included. ALF developed in 208 patients (56%) and HH in 27 (7%); 24 patients developed both conditions. Patients with HH had higher mortality (89% vs. 51% vs. 45%, respectively) and greater rates of unfavourable neurological outcome (93% vs. 60% vs. 59%, respectively) compared to those with ALF without HH (n = 184) and those without ALF or HH (n = 163; p = 0.03). Unwitnessed arrest, non-shockable initial rhythm, lack of bystander cardiopulmonary resuscitation, high adrenaline doses and the development of acute kidney injury were independent predictors of unfavourable neurological outcome; HH (OR: 16.276 [95% CIs: 2.625-81.345; p = 0.003), but not ALF, was also a significant risk-factor for unfavourable outcome. Although ALF occurs frequently after CA, HH is a rare complication. Only HH is significantly associated with poor neurological outcome in this setting.http://europepmc.org/articles/PMC6218055?pdf=render |
| spellingShingle | Enrica Iesu Federico Franchi Federica Zama Cavicchi Selene Pozzebon Vito Fontana Manuel Mendoza Leda Nobile Sabino Scolletta Jean-Louis Vincent Jacques Creteur Fabio Silvio Taccone Acute liver dysfunction after cardiac arrest. PLoS ONE |
| title | Acute liver dysfunction after cardiac arrest. |
| title_full | Acute liver dysfunction after cardiac arrest. |
| title_fullStr | Acute liver dysfunction after cardiac arrest. |
| title_full_unstemmed | Acute liver dysfunction after cardiac arrest. |
| title_short | Acute liver dysfunction after cardiac arrest. |
| title_sort | acute liver dysfunction after cardiac arrest |
| url | http://europepmc.org/articles/PMC6218055?pdf=render |
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