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

Table 1 Clinical characteristics of patients with severe hypoxic hepatitis n (%)

	n = 75
Demographics
Age	61.9 ± 16.6
Male gender	43 (57.3)
Race (Chinese/Malay/Indian)	51/20/4 (68/26.7/5.3)
Pre-existing co-morbidities
Pre-existing ischemic heart disease	41 (54.7)
Pre-existing cardiac failure	27 (36.0)
Pre-existing renal failure	27 (36.0)
Pre-existing chronic viral hepatitis	5 (6.7)
Precipitating conditions
Documented hypotension	55 (73.3)
Documented bradycardia	11 (14.7)
Documented metabolic acidosis	43 (57.3)
Baseline laboratory parameters1
Albumin (g/L)	25.3 ± 6.9
Bilirubin (μmol/L)	76.1 ± 82.6
GGT (U/L)	126 ± 90
Creatinine (mmol/L)	321 ± 211
Prothrombin time (seconds)	27.8 ± 12.2
ALT (U/L)	2295 ± 1656
AST (U/L)	4896 ± 2986
ALT/AST ratio_D12	0.70 ± 1.36
Peak ALT (U/L)	2834 ± 1938
Peak AST (U/L)	5894 ± 3148
Clinical outcome
Admitted to ICU	50 (66.7)
Died within same admission	53 (70.7)

¹Measured at onset of severe hypoxic hepatitis;

²Ratio of the ALT to AST at the first documentation of either ALT or AST > 3000U/L. AST: Aspartate transaminase; ALT: Alanine transaminase; GGT: Gamma glutamyl transferase; ICU: Intensive care unit.

Table 2 Comparison between patients with severe hypoxic hepatitis who died and survived n (%)

	Died (n = 53)	Survived (n = 22)	P value
Demographics
Age	64.3 ± 17.6	56.3 ± 12.8	0.059
Male gender	35 (66.0)	8 (36.4)	0.018
Race (Chinese/Malay/Indian)	36/13/4	15/7/0	0.373
Pre-existing co-morbidities
Pre-existing ischemic heart disease	27 (50.9)	12 (54.5)	0.793
Pre-existing cardiac failure	16 (30.2)	11 (50.0)	0.104
Pre-existing renal failure	19 (35.8)	8 (36.4)	0.966
Precipitating conditions
Documented hypotension	45 (84.9)	14 (63.6)	0.041
Documented bradycardia	9 (17.0)	2 (9.1)	0.379
Documented metabolic acidosis	33 (62.3)	10 (45.5)	0.180
Baseline laboratory parameters1
Albumin (g/L)	23.7 ± 6.8	29.1 ± 5.8	0.001
Bilirubin (μmol/L)	79.2 ± 84.4	68.8 ± 79.7	0.625
ALT (U/L)	2051 ± 1601	2880 ± 1674	0.048
AST (U/L)	5093 ± 2943	4440 ± 3103	0.395
ALT/AST ratio_D12	0.50 ± 0.80	1.18 ± 2.15	0.051
GGT (U/L)	111 ± 67	158 ± 123	0.161
Creatine kinase	2949 ± 6180	395 ± 419	0.006
Creatine kinase MB	37.1 ± 56.6	13.5 ± 20.7	0.015
Troponin T (Trop T)	2.02 ± 4.21	0.49 ± 1.42	0.031
Lactate dehydrogenase	2503 ± 2552	4035 ± 3671	0.229
Creatinine (mmol/L)	297.3 ± 172.9	376.6 ± 276.3	0.143
Prothombin time (seconds)	27.8 ± 12.5	27.7 ± 11.9	0.980
Peak ALT (U/L)	2572 ± 2026	3464 ± 1575	0.069
Peak AST (U/L)	6223 ± 3138	5131 ± 3110	0.176

¹Measured at onset of severe hypoxic hepatitis;

²Ratio of the ALT to AST at the first documentation of either ALT or AST > 3000 U/L. AST: Aspartate transaminase; ALT: Alanine transaminase; GGT: Gamma glutamyl transferase.

Table 3 Univariate and multivariable analysis of predictive factors for mortality in severe hypoxic hepatitis

Variable	Univariate analysis		Multivariable analysis
	HR (95%CI)	P value	HR (95%CI)	P value
Age	1.03 (0.99-1.06)	0.069	1.07 (0.99-1.14)	0.056
Male gender	0.29 (0.10-0.83)	0.021	0.17 (0.03-1.19)	0.074
Precipitating hypotensive episode	3.21 (1.02-10.14)	0.046	4.40 (0.47-40.9)	0.192
Albumin	0.88 (0.80-0.96)	0.004	0.83 (0.71-0.96)	0.015
ALT	1.00 (0.99-1.00)	0.054	1.00 (1.00-1.00)	0.609
Creatine kinase	1.00 (1.00-1.00)	0.032	1.00 (1.00-1.00)	0.068
Creatine kinase MB	1.02 (0.99-1.05)	0.122	0.98 (0.94-1.02)	0.330
Troponin T	1.39 (0.88-2.16)	0.178	1.29 (0.74-2.27)	0.374
ALT/AST ratio_D11	0.65 (0.35-1.19)	0.160	0.22 (0.04-13.1)	0.465

¹Ratio of the ALT to AST at the first documentation of either ALT or AST > 3000 U/L. ALT: Alanine transaminase; AST: Aspartate transaminase.