Short-term changes in liver tests predict long-term mortality

Abstract

ObjectiveTo determine whether short-term changes in liver tests (bilirubin, albumin, gamma glutamyl transferase, alkaline phosphatase, alanine aminotransferase (ALT) and aspartate aminotransferase) predict 12-month mortality and, if so, which test is most informative.DesignRetrospective review of general medicine inpatients at a tertiary hospital (2005–2012) identified non-elective admissions of minimum 7 days’ duration. Patients with liver disease, malignancy, admission to the intensive care unit or inpatient mortality were excluded. Linear spline modelled the vector of intra-admission change from admission. The association between 12-month mortality and admission and intra-admission changes in liver tests was assessed by logistic regression modelling, adjusted for age, gender, comorbidity index and heart failure.Results12-month mortality was 17% in 4160 patients analysed. 12-month mortality for patients with abnormally low albumin at admission was 5% higher per 1 g/L below 34 g/L (OR 0.95, 95% CI 0.93 to 0.98, p<0.001). Albumin and ALT were the only tests for which an intra-admission change significantly predicted mortality; the predictive effects were additive. 12-month mortality was greater by 4% per 1 g/L intra-admission decrement in albumin (OR 1.04, 95% CI 1.02 to 1.06, p<0.001) and 6% per 100 IU/L intra-admission increment in ALT (OR 1.06, 95% CI 1.02 to 1.1, p=0.005). Intra-admission changes were superior to admission values in predicting mortality.ConclusionsChanges in liver tests predict long-term mortality better than a single value and provide prognostic information more quickly than long-term monitoring. In the absence of known liver disease, albumin predicts long-term mortality better than transaminases. The patient whose albumin decreases in the short term is at high risk of death within 1 year, even from a normal baseline.

Predictors of Three-month Hospital Readmissions and Mortality in Patients with Cirrhosis of Liver

“…The elevated values have more significance in the absence of apparent liver diseases. 27 Current study results did not find any deviation in the results from the established understanding.…”

Predicting drug-induced liver injury from anti-tuberculous medications by early monitoring of liver tests

“…Few other studies have addressed ALT kinetics in monitoring TB treatment [16], although a similar method was employed to assess the impact of short-term LT changes in an unselected cohort of general medical admission and was shown to predict 12-month mortality [17]. A notable exception is the investigation by Singanayagam and colleagues reporting outcomes of TB-DILI screening strategies conducted in a similar London population to our study [4].…”

Commonly used clinical chemistry tests as mortality predictors: Results from two large cohort studies

“…On the other hand, in other conditions in which conjugated hyperbilirubinemia is common, like in heart failure, high bilirubin levels are associated with an increased mortality [ 18 , 19 ]. Further, high levels of other liver function tests, such as aspartate transaminase, GGT and ALP, have been linked to increased mortality in heart failure patients [ 19 ]; but in one study of general admissions to the hospital, neither bilirubin nor other liver function tests predicted 12 month mortality, while low levels of albumin did [ 20 ].…”