Association of Low Alanine Aminotransferase Values with Extubation Failure in Adult Critically Ill Patients: A Retrospective Cohort Study

Abstract

Background: Liberation from mechanical ventilation is a cardinal landmark during hospitalization of ventilated patients. Decreased muscle mass and sarcopenia are associated with a high risk of extubation failure. A low level of alanine aminotransferase (ALT) is a known biomarker of sarcopenia. This study aimed to determine whether low levels of ALT are associated with increased risk of extubation failure among critically ill patients. Methods: This was a retrospective single-center cohort study of mechanically ventilated patients undergoing their first extubation. The study’s outcome was extubation failure within 48 h and 7 days. Multivariable logistic and Cox regression were performed to determine whether ALT was an independent predictor of these outcomes. Results: The study included 329 patients with a median age of 62.4 years (IQR 48.1–71.2); 210 (63.8%) patients were at high risk for extubation failure. 66 (20.1%) and 83 (25.2%) failed the extubation attempt after 48 h and 7 days, respectively. Low ALT values were more common among patients requiring reintubation (80.3–61.5% vs. 58.6–58.9%, p < 0.002). Multivariable logistic regression analysis identified ALT as an independent predictor of extubation failure at 48 h and 7 days. ALT ≤ 21 IU/L had an adjusted hazard ratio (HR) of 2.41 (95% CI 1.31–4.42, p < 0.001) for extubation failure at 48 h and ALT ≤ 16 IU/L had adjusted HR of 1.94 (95% CI 1.25–3.02, p < 0.001) for failure after 7 days. Conclusions: Low ALT, an established biomarker of sarcopenia and frailty, is an independent risk factor for extubation failure among hospitalized patients. This simple laboratory parameter can be used as an effective adjunct predictor, along with other weaning parameters, and thereby facilitate the identification of high-risk patients.

High Serum AST/ALT Ratio and Low Serum INS*PA Product Are Risk Factors and Can Diagnose Sarcopenia in Middle-Aged and Older Adults

“…Generally, high ALT or AST values (>40 IU/L) are considered pathological and reflect liver damage, caused by hepatitis, etc. (11). Another study also reported that low ALT activity in the peripheral blood is a surrogate marker for low general body muscle mass and sarcopenia (12).…”

Predictive value of diaphragmatic thickness fraction and integrated pulmonary index on extubation outcome in patients with severe acute pancreatitis

“… 15 Premature discontinuation of ventilation can place the respiratory and cardiovascular systems under severe stress, hindering the patient’s recovery. However, prolonged use of ventilation can lead to a series of complications such as disuse atrophy of the diaphragm and ventilator-associated pneumonia, 16 , 17 while also prolonging the patient’s hospital stay and increasing the economic burden on the family. Therefore, identifying indicators that can efficiently and accurately predict the outcome of weaning is of great clinical significance to improving the success rate of weaning.…”

Is The Serum Creatinine / Alanine Transaminase Ratio A Predictor Of Mortality In Elderly Patients With Acute Ischemic Stroke?

“…Signi cantly decreased serum ALT is an independent risk factor for mortality in the elderly population [21]. Again, a study including 329 patients with a median age of 62.4 years reported that sarcopenia and low ALT values, an established biomarker of frailty, are an independent risk factor for extubation failure in hospitalized patients [22]. A study examining the data of 51 831 patients with a mean age of 70.88 showed that low ALT < 10 IU/l values were associated with mortality [23].…”