Low serum albumin predicts early mortality in patients with severe hypoxic hepatitis

Chang, Pik‐Eu; Goh, George Boon-Bee; Ekstrom, Victoria; Ong, M.E.; Tan, Chee‐Kiat

doi:10.4254/wjh.v9.i22.959

Cited by 13 publications

(15 citation statements)

References 40 publications

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“…On the other hand, three different α-HA of amino acid origin (α-hydroxyisovaleric acid, α-hydroxybutyric, and 2,3 dihydroxybutanoic acid) were signi cantly increased in samples from mild and severe COVID-19 patients and positively correlated with CRP and LDH and negatively with SO2 and serum albumin. Reduced levels of this protein have been associated with increased mortality in severe hypoxic hepatitis and COVID-19 [23][24][25] . Similar to glutathione, albumin has an antioxidant activity over ROS control in ischemic and hypoxic liver 26 .…”

Section: Discussionmentioning

confidence: 99%

COVID-19 Metabolomic Profile: A Link Between Lung Dysfunction Markers and Altered Amino Acid Metabolism

Páez-Franco¹,

Torres-Ruíz²,

Sosa-Hernández³

et al. 2020

Preprint

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We identified the main changes in serum metabolites associated with severe (n=46) and mild (n=19) COVID-19 patients by gas chromatography coupled to mass spectrometry. The modified metabolic profiles were associated to an altered amino acid catabolism in hypoxic conditions. Noteworthy, three 𝛼-hydroxyl acids of amino acid origin increased with disease severity and correlated with altered oxygen saturation levels and clinical markers of lung damage. We hypothesize that the enzymatic conversion of 𝛼-keto-acids to 𝛼- hydroxyl-acids helps to maintain NAD recycling in patients with altered oxygen levels, highlighting the potential relevance of amino acid supplementation during SARS-CoV-2 infection.

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Section: Discussionmentioning

confidence: 99%

COVID-19 Metabolomic Profile: A Link Between Lung Dysfunction Markers and Altered Amino Acid Metabolism

Páez-Franco¹,

Torres-Ruíz²,

Sosa-Hernández³

et al. 2020

Preprint

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“…This study showed a significant difference in AST levels between survivors and non-survivors. One study showed that, among patients with severe hypoxic hepatitis, indicated by mean AST levels of 4896 U/L, low serum albumin levels predicted early mortality 14 . Another study reported a strong relationship between aminotransferase concentrations, including AST, and mortality from liver disease 15 .…”

Section: Discussionmentioning

confidence: 99%

A retrospective cross-sectional study for predicting 72-h mortality in patients with serum aspartate aminotransferase levels ≥ 3000 U/L

Saito

Sugawara

Watanabe

et al. 2021

Sci Rep

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Risk factors associated with 72-h mortality in patients with extremely high serum aspartate aminotransferase levels (AST; ≥ 3000 U/L) are unknown. This single-centre, retrospective, case-controlled, cross-sectional study obtained data from medical records of adult patients treated at Saitama Medical Center, Japan, from 2005 to 2019. We conducted a multivariate logistic after adjusting for age, sex, height, weight, body mass index, Brinkman Index, vital signs, biochemical values, updated Charlson Comorbidity Index (CCI) score, CCI components, and underlying causes. A logistic regression model with selected validity risks and higher C-statistic for predicting 72-h mortality was established. During the 15-year period, 428 patients (133 non-survivors and 295 survivors [cases and controls by survival < 72 and ≥ 72 h, respectively]) with AST levels ≥ 3000 U/L were identified. The 72-h mortality rate was 133/428 (31.1%). The model used for predicting 72-h mortality through the assessment of alkaline phosphatase, creatine kinase, serum sodium, potassium, and phosphorus levels had a C-statistic value of 0.852 (sensitivity and specificity, 76.6%). The main independent risk factors associated with 72-h mortality among patients with AST levels ≥ 3000 U/L included higher serum values of alkaline phosphatase, creatine kinase, serum sodium, potassium, and phosphorus.

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“…Independent predictors of 28‐day mortality included septic shock, cardiogenic shock, history of COPD, metabolic acidosis, raised prothrombin time, and older age. Previous studies in patients with ischemic hepatitis have identified various independent risk factors of mortality: older age, higher ICU severity scores, septic shock, higher international normalized ratio, renal failure, higher bilirubin, higher lactate dehydrogenase, lower albumin, and requirement of vasopressors . However, the study populations have been heterogeneous and typically included ICU patients or patients with severe liver injury with ALT over 3000–4000 IU/L, and none have been conducted on an Australian population.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies in patients with ischemic hepatitis have identified various independent risk factors of mortality: older age, higher ICU severity scores, septic shock, higher international normalized ratio, renal failure, higher bilirubin, higher lactate dehydrogenase, lower albumin, and requirement of vasopressors. 8,[25][26][27][28] However, the study populations have been heterogeneous and typically included ICU patients or patients with severe liver injury with ALT over 3000-4000 IU/L, and none have been conducted on an Australian population. Our findings have important clinical relevance and suggest that marked ALT derangement warrants urgent investigation to elicit etiology as they confer vastly different mortality risks.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology and outcomes of marked elevations of alanine aminotransferase >1000 IU/L in an Australian cohort

et al. 2019

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Background and Aim Marked elevations of alanine aminotransferase (ALT) are caused by a limited number of underlying pathologies, including hepatic ischemia, drugs/toxins, viral hepatitis, and—rarely—autoimmune hepatitis. The aim of this study was to determine the relative incidence of pathologies resulting in ALT greater than 1000 IU/L and factors predicting clinical outcomes in an Australian cohort. Methods A retrospective cohort study of all adult patients with ALT levels greater than 1000 IU/L between January 2013 and December 2015 was conducted at a large teaching hospital network in Australia. Multivariable logistic regression analysis was used to determine predictors of etiology and mortality. Results There were 287 patients identified with ALT levels greater than 1000 IU/L. The most common causes were ischemia (44%), drugs/toxins (19%), biliary obstruction (16%), and viral hepatitis (7%). Independent predictors of a diagnosis of ischemic hepatitis included (adjusted odds ratio; 95% confidence interval): hypotension (29.2; 8.2–104.7), chronic obstructive pulmonary disease (COPD) (20.2; 2.8–145.3), coronary artery disease (12.9; 1.7–98.9), congestive cardiac failure (7.8; 1.2–49.2), diabetes mellitus (7.4; 1.6–33.9), metabolic acidosis (6.2; 2.0–19.4), gamma‐glutamyltransferase < 135 IU/L (5.1; 1.5–17.6), and albumin <34 g/L (3.4; 1.1–11.0). Independent risk factors for all‐cause 28‐day mortality included: septic shock (14.7; 4.3–50.7), metabolic acidosis (7.3; 2.5–21.3), history of COPD (5.4; 1.6–17.8), cardiogenic shock (4.3; 1.6–11.7), prothrombin time ≥ 20 s (3.7; 1.5–9.2), and age ≥ 65 years (3.0; 1.3–7.2). Conclusions Ischemic hepatitis was the most common cause of ALT levels greater than 1000 IU/L and was associated with high mortality.

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Low serum albumin predicts early mortality in patients with severe hypoxic hepatitis

Cited by 13 publications

References 40 publications

COVID-19 Metabolomic Profile: A Link Between Lung Dysfunction Markers and Altered Amino Acid Metabolism

COVID-19 Metabolomic Profile: A Link Between Lung Dysfunction Markers and Altered Amino Acid Metabolism

A retrospective cross-sectional study for predicting 72-h mortality in patients with serum aspartate aminotransferase levels ≥ 3000 U/L

Epidemiology and outcomes of marked elevations of alanine aminotransferase >1000 IU/L in an Australian cohort

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