Hypoxic hepatitis in cardiac intensive care unit: a study of cardiovascular risk factors, clinical course, and outcomes

Figures & data

Table 1 Demographic and clinical characteristics of patients in the cardiac intensive care unit

	Group 1 (n=18)	Group 2 (n=18)	Group 3 (n=18)	P-value
Male n (%)	12 (66.7%)	12 (66.7%)	12 (66.7%)	1
Age (years)	61±17	61±17	60±17	0.998
Body mass index (kg/m^2)	27±5	29±6	27±6	0.374
Diabetes mellitus n (%)	5 (27.8%)	4 (22.2%)	7 (38.9%)	0.53
High blood pressure n (%)	7 (38.9%)	11 (61.1%)	8 (44.4%)	0.38
Heart failure n (%)	0	1 (5.6%)	1 (5.6%)	0.59
Cardiovascular disease n (%)	5 (27.8%)	7 (38.9%)	6 (33.3%)	0.77
Chronic liver disease n (%)	2 (11.1%)	0	1 (5.6%)	0.34
Chronic lung disease n (%)	1 (5.6%)	2 (11.1%)	1 (5.6%)	0.76
Chronic kidney disease n (%)	1 (5.6%)	3 (16.7%)	3 (16.7%)	0.51
Diagnosis
Myocardial infarction n (%)	8 (44.4%)	11 (61.1%)	7 (38.9%)	0.308
Cardiac arrhythmia n (%)	3 (16.8%)	1 (5.6%)	1 (5.6%)
Acute aortic syndrome n (%)	1 (5.6%)	0	3 (16.7%)
Acute heart failure n (%)	0	3 (16.7%)	1 (5.6%)
Pulmonary embolism n (%)	2 (11.1%)	1 (5.6%)	1 (5.6%)
Tamponade n (%)	3 (16.7%)	0	1 (5.6%)
Hospital stay (days)	8±5	8±5	8±6	0.990
Intensive care unit stay (days)	4±2	5±3	4±4	0.470
Mortality n (%)	10 (55.6%)	6 (35.3%)	2 (11.1%)	0.019

Note: Data are expressed as mean ± standard deviation or n (%).

Table 2 Hemodynamic status, hemodynamic drugs, and echocardiographic parameters

	Total (n=54)	Group 1 (n=18)	Group 2 (n=18)	Group 3 (n=18)	P-value
Shock	38 (70.4)	17 (94.4)	14 (77.8)	7 (38.9)	0.001
Cardiogenic shock	31 (57.4)	12 (66.7)	13 (72.2)	6 (33.3)
Septic shock	3 (5.6)	2 (11.1)	1 (5.6)	0	0.006
Mixed shock	4 (7.4)	3 (16.7)	0	1 (5.6)
Dopamine	19 (35.2)	8 (44.4)	6 (33.3)	5 (27.8)	0.566
Norepinephrine	37 (68.5)	16 (88.9)	14 (77.8)	7 (38.9)	0.003
Vasopressin	27 (50)	12 (66.7)	10 (55.6)	5 (27.8)	0.056
Epinephrine	9 (16.7)	3 (16.7)	5 (27.8)	1 (5.6)	0.202
Levosimendan	33 (61.1)	13 (72.2)	13 (72.2)	7 (38.9)	0.060
Phenylephrine	11 (20.4)	8 (44.4)	2 (11.1)	1 (5.6)	0.007
Dobutamine	4 (7.4)	1 (5.6)	1 (5.6)	2 (11.1)	0.763
Intra-aortic balloon pump	10 (18.5)	4 (22.2)	4 (22.2)	2 (11.1)	0.612
CVP lowest (cmH2O)a		8±5*	6±5	2±5	0.006
CO lowest (L/min)a		4.1±2.1	3.5±1.8	4.9±2.3	0.704
MAP lowest (mmHg)		54±15	58±14	59±14	0.602
SAP lowest (mmHg)		73±25	83±15	87±20	0.112
CI lowest (L/min/m^2)a		2.3±1.1	1.6±0.9	2.7±1.2	0.429
TAPSE (mm)		15±6*	18±4	22±6	0.035
EF LV by Teichholz formula (%)a		52±18	56	59±21	0.863
EF LV by Simpson’s rule (%)a		41±15	45±11	53±15	0.058

Notes: Data are expressed as mean ± standard deviation or n (%).

a Some data are missing.

* P<0.05 versus Group 3.

Abbreviations: CI, cardiac index; CO, cardiac output; CVP, central venous pressure; EF, ejection fraction; LV, left ventricle; MAP, mean arterial pressure; SAP, systolic arterial pressure; TAPSE, tricuspid annular plane systolic excursion.

Table 3 Baseline and maximum levels of aspartate aminotransferase, alanine aminotransferase, and lactic dehydrogenase

	Group 1 (n=18)	Group 2 (n=18)	Group 3 (n=18)	P-value
Baseline AST (U/L)	1,521±2,320*,**	260±185	55±49	0.004
	451 (35–9,597)	281 (25–670)	36 (14–192)
AST max (U/L)	3,275±3,001*,**	394±122	60±49	0.001
	2,205.5 (1,077–12,261)	376.5 (236–670)	43.5 (14–192)
Baseline ALT (U/L)	810±954*,**	159±131	43±45	0.0001
	389.5 (19–3,215)	106 (12–384)	29 (9–197)
ALT max (U/L)	1,736±1,378*,**	227±132	44±44	0.001
	1,394 (502–6,243)	236 (58–443)	29 (9–197)
Baseline LDH (U/L)	2,058±2,398*,**	541±355	249±131	0.001
	1,057 (255–5,264)	403.5 (175–1,301)	230.5 (93–576)
LDH max (U/L)	4,425±3,199*,**	831±310	266±141	0.001
	3,862 (1,544–14,679)	864.5 (564–1,408)	241.5 (111–576)

Notes: Data are expressed as mean ± standard deviation or median (minimum–maximum).

* P<0.05 versus Group 2;

** P<0.05 versus Group 3.

Abbreviations: AST, aspartate aminotransferase; ALT, alanine aminotransferase; LDH, lactic dehydrogenase.

Table 4 Evaluation of ventilatory function by group

	Group 1 (n=17)	Group 2 (n=15)	Group 3 (n=13)	P-value
PaCO2 higher (mmHg)	41±14	37±10	39±6	0.575
PaO2 lower (mmHg)	67±27	118±84***	63±14	0.009
SaO2 lower (%)	82±16*	93±6	90±8	0.026
Serum lactate higher (mmol/L)	8.8±6.6**	6.6±4.3	2.7±1.9	0.005
Kirby Index lower (mmHg)	93±73*	167±88	125±82	0.046
O2 A–a gradient (mmHg)	368±133*	282±153	309±166	0.264
Shunts higher (%)	39±16	25±11	27±12	0.014
Mechanical ventilation	12 (70.6)	11 (61.1)	5 (27.8)	0.028

Notes: Data are expressed as mean ± standard deviation or n (%).

* P<0.05 versus Group 2;

** P<0.05 versus group 3;

*** P<0.05 versus Group 3.

Abbreviations: A–a, alveolar–arterial; O₂, oxygen; PaCO₂, carbon dioxide arterial pressure; PaO₂, oxygen arterial pressure; SaO₂, oxygen saturation.

Table 5 Evaluation of renal function by group

	Group 1 (n=18)	Group 2 (n=18)	Group 3 (n=18)	P-value
Baseline blood urea nitrogen (mg/dL)	37±27	24±14	35±47	0.420
	27.4 (11.5–108.6)	17.9 (9.7–45.5)	17.75 (10.6–214.4)
Highest blood urea nitrogen (mg/dL)	41±26	28±18	48±52	0.221
	30.55 (14–108.6)	22.6 (9.7–70.5)	24.4 (10.6–214.4)
Baseline creatinine (mg/dL)	2.9±4.9	1.4±0.9	1.9±2.6	0.412
	1.22 (0.8–21.76)	1.19 (0.66–4.52)	1.175 (0.64–12.32)
Highest creatinine (mg/dL)	2.9±4.8	1.7±1.3	2.4±2.9	0.522
	1.45 (0.8–21.7)	1.3 (0.78–6.28)	1.19 (0.72–12.32)
Dialysis n (%)	4 (22.2)	2 (11.8)	3 (17.6)	0.715

Note: Data expressed as mean ± standard deviation, median (minimum–maximum), or n (%).

Table 6 Clinical features according to mortality

Clinical feature	Survived (n=36)	Died (n=18)	P-value
Shock state	20 (55.6)	18 (100)	0.001
Cardiogenic shock	16 (44.4)	15 (83.3)
Septic shock	2 (5.6)	1 (5.6)	0.009
Mixed shock	2 (5.6)	2 (11.1)
Use of dopamine	11 (30.6)	8 (44.4)	0.239
Use of norepinephrine	20 (55.6)	17 (94.4)	0.003
Use of vasopressin	12 (33.3)	15 (83.3)	0.001
Use of adrenaline	3 (8.3)	6 (33.3)	0.029
Use of levosimendan	20 (55.6)	13 (72.2)	0.188
Use of phenylephrine	4 (11.1)	7 (38.9)	0.023
Use of dobutamine	4 (11.1)	0	0.186
Use of intra-aortic balloon pump	1 (2.8)	9 (50)	0.001
Mechanical ventilation	13 (36.1)	15 (88.2)	0.001
Dialysis	4 (11.8)	5 (27.8)	0.143

Note: Data are expressed as n (%).