Postoperatively Increased Serum Alanine Aminotransferase Level Is Closely Associated with Mortality after Cardiac Surgery

Abstract

Background Hepatic biomarkers are often not assessed routinely after cardiac surgery. Alanine aminotransferase (ALT) has become the primary biomarker of any type of liver injury. Our purpose was to study the prognostic value of serum ALT in early and late mortality.

Methods Patients subjected to any type of cardiac operation from January 1999 through December 2010 were studied. According to postoperative maximum ALT level, four groups were created: group 1 = ALT ≤ 50 U/L (n = 8,669), group 2 = ALT 50 to 150 U/L (n = 3,055), group 3 = ALT 151 to 500 U/L (n = 248), and group 4 = ALT > 500 U/L (n = 50). Cox multivariate modeling was used for survival analysis.

Results Patients in groups 3 and 4 had increased 30-day mortality (hazard ratio [HR] = 8.07 [4.15–15.69], p < 0.001 and HR = 19.07 [9.88–36.80], p < 0.001, respectively). Late mortality was increased for group 4 after final adjustments (HR = 1.87 [1.18–2.95], p = 0.007).

Conclusion Elevated postoperative ALT level (above 150 U/L) is closely associated with early mortality after cardiac surgery. ALT level above 500 U/L implies a substantial liver dysfunction with a considerable negative association on both early and late survival.

Keywords

cardiac - outcomes - statistics

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