Background: Aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AST/ALT) frequently is used in the diagnosis and prognosis of liver diseases, however it is also used in the diagnosis and prognosis of many other diseases, such as myocardial infarction, acute ischemic stroke, and peripheral artery disease. Acute kidney injury (AKI) is one of the most important complications after cardiac surgery and is one of the main causes of morbidity and mortality. The purpose of the study was to analyze the relationship between AST to ALT and AKI after isolated coronary artery bypass graft surgery (CABG). Methods: We retrospectively reviewed the prospectively collected data of 253 adult patients, who underwent isolated CABG surgery with normal renal function (baseline serum creatinine value <1.4 mg/dL). Preoperative (T0) and postoperative day 1 and day 3 (T1 and T2) serum AST and ALT levels were analyzed, and AST/ALT was calculated. A preoperative AST/ALT of 1.22 was found to be the best cutoff point for predicting postoperative AKI. Kidney injury was interpreted, according to RIFLE classification. The effect of AST to ALT ratio on AKI after CABG was determined using logistic regression analysis, and the results were expressed as odds ratio (OR) with a 95% confidence interval (CI). A P value < .05 was considered statistically significant. Results: Postoperative AKI occurred in 40 patients (15.8%). On logistic regression analysis, higher AST/ALT both preoperatively and postoperatively were associated with an increased incidence of postoperative AKI (T0: OR, 3.983; 95% CI, 1.940-8.180, P < .001, T1: OR, 2.760; 95% CI, 1.381-5.515, P = .004, T2: OR, 2.515; 95% CI, 1.195-5.294, P = .015). Conclusion: Preoperative and postoperative elevated AST to ALT ratio seems to be associated with an increased incidence of AKI after elective isolated CABG surgery.
Background: Subclinical or biochemically diagnosed hypothyroidism (SCH) is defined as an elevated serum thyroid-stimulating hormone (TSH) with normal free thyroxine (FT4) levels. Thyroid hormones play a major role in the normal function of the heart and vascular physiology. Atherosclerosis, increased systemic vascular resistance, and decreased arterial compliance are common pathophysiological changes that may occur in hypothyroidism. Acute kidney injury (AKI) is one of the devastating complications after cardiac surgery. Age, diabetes mellitus (DM), preexisting renal dysfunction, hypertension, impaired left ventricular function, and severe arteriosclerosis are the major risk factors for the development of AKI. The purpose of the current study was to analyze the influence of SCH on AKI and the requirement of renal replacement therapy (RRT) after isolated coronary artery bypass graft surgery (CABG). Methods: We retrospectively reviewed the prospectively collected data of 336 adult patients who underwent isolated CABG surgery with normal renal function (baseline serum creatinine value <1.4 mg/dL) from January 2017 to January 2019. The patients were divided into two groups either having the diagnosis of SCH (Group I, N = 47) or not (Group II, N = 289). SCH was diagnosed based on preoperative serum TSH and FT4 levels. Kidney injury was interpreted, according to RIFLE classification. The effect of SCH on AKI and the need for RRT after CABG was determined using logistic regression analysis and the results were expressed as odds ratio (OR) with a 95% confidence interval (CI). A P value < .05 was considered statistically significant. Results: Subclinical hypothyroidism was diagnosed in 14% of all patients. Postoperative AKI occurred in 15 patients (31.9%) in Group I, whereas there were 42 patients (14.5%) in Group II. On logistic regression analysis, the presence of SCH was shown to be associated with an increased incidence of postoperative AKI (OR, 0.363; 95% CI, 0.181-0.727; P = .004). RRT was used in 2.97% of patients (seven patients in Group I and three patients in Group II, P < .001). The 30-day mortality was 2.1%. Conclusion: The presence of SCH seems to be associated with an increased incidence of AKI and increased requirement for RRT after cardiac surgery.
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