The Relationship Between Changes in Liver Enzymes and Mortality of Patients Admitted to a Surgical Intensive Care Unit

Abstract

Background: Increased levels of alanine transaminase (ALT) and alkaline phosphatase in the liver are associated with an increased risk of mortality in hospitalized patients. This study aimed to survey the relationship between changes in liver enzymes and mortality of patients admitted to a surgical intensive care unit (ICU). Methods: This cross sectional study was based on the electronic and clinical records of patients, hospitalized in the ICU of Rasool Akram hospital from 2012 to 2015. The information of 199 alive and 140 deceased patients was studied. The laboratory parameters, clinical information, acute physiology and chronic health evaluation (APACHE-II) scores, and sequential organ failure assessment (SOFA) scores were determined upon admission, and length of ICU stay was measured. Results: There was a significant difference in the aspartate aminotransferase (AST) level upon admission in alive and deceased groups (42.01 ± 46.65 and 58.54 ± 80.95 mg/dL, respectively) (P < 0.05). However, there was no significant difference in the level of AST at discharge between the groups (39.05 ± 36.69 and 67.95 ± 21.7mg/dL, respectively) (P > 0.05). There was a significant difference in the level of ALT upon admission between the groups (34.21 ± 58.13 and 41.32 ± 66.77 mg/dL, respectively) (P > 0.05). However, there was no significant difference in ALT level at discharge between the groups (38.44 ± 48.69 and 42.94 ± 76.47 mg/dL, respectively) (P > 0.05). Based on the multivariate logistic regression model, the predictive factors for mortality included use of inotropes, alkaline phosphatase, and reduced platelet count, potassium level, and heart rate. Conclusions: Measurement of serum liver enzymes has inadequate predictive value for mortality in ICU patients.