Abstract
BACKGROUND: Liver synthetic dysfunction predicts outcomes in cardiac intensive care unit (CICU) patients. OBJECTIVES: The purpose of this study was to evaluate the associations between the severity and extent of admission liver function test (LFT) abnormalities and mortality in a mixed CICU population. METHODS: This historical cohort study included unique CICU patients from 2007 to 2018 with available data for admission LFT values. We categorized each LFT from grade 0 to grade 4 based on multiples of the upper limit of normal. We evaluated in-hospital mortality using logistic regression and 1-year mortality using Cox proportional hazards regression. RESULTS: We included 7,284 patients, and 3,477 (47.7%) had at least 1 LFT with grade 1 or greater. In-hospital mortality was higher for patients with 1 or more abnormal LFTs (17.9% vs 6.4%; adjusted OR: 1.54 [95% CI: 1.27-1.86]; P < 0.001). A stepwise increase in in-hospital mortality was observed with increasing LFT grade, both overall (adjusted OR: 1.25 [95% CI: 1.16-1.34] per each higher grade; P < 0.001) and for each individual LFT. Each additional abnormal LFT was associated with higher in-hospital mortality (adjusted OR: 1.19 [95% CI: 1.10-1.29] per each; P < 0.001). One-year mortality was significantly higher in patients with abnormal LFT values (unadjusted HR: 1.70 [95% CI: 1.56-1.86]; P < 0.001) and increased incrementally as a function of the severity and extent of LFT abnormality. CONCLUSIONS: The severity and extent of LFT abnormalities are positively associated with in-hospital and 1-year mortality in CICU patients. Cardiohepatic syndrome is an important predictor of prognosis in CICU patients, and inclusion of LFTs in future risk-prediction tools could enhance prognostication.