Chin Ji-Hyun, Jo Jun-Young, Lee Eun-Ho, Kim Wook-Jong, Choi Dae-Kee, Sim Ji-Yeon, Choi Kyu Taek, Choi In-Cheol
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
J Cardiothorac Vasc Anesth. 2018 Jun;32(3):1236-1242. doi: 10.1053/j.jvca.2017.08.012. Epub 2017 Aug 3.
To evaluate the prognostic impacts of postoperative increases in serum amino transaminases on 1-year mortality in patients who underwent coronary artery bypass graft.
A retrospective analysis.
A tertiary care university hospital.
A total of 1,950 patients who underwent coronary artery bypass graft.
None.
Aspartate amino transaminase and alanine amino transaminase ratios were calculated as the ratio between the peak aspartate amino transaminase and alanine amino transaminase within the first 5 post-operative days and their respective upper limit of normal values. A ratio of 2.0 was seen to be the minimum for which a difference in 1-year mortality could be detected in univariate analysis, when considering simultaneously both aspartate amino transaminase and alanine amino transaminase ratios. Multivariable analysis showed an association between an aspartate amino transaminase ratio > 2.0 and increased 1-year mortality (hazard ratio [HR] 2.68, 95% confidence interval [CI] 1.42-5.05, P = 0.002), and also between both an aspartate amino transaminase and alanine amino transaminase ratio > 2.0 and increased 1-year mortality (HR 3.90, 95% CI 1.87-8.14, P < 0.001). However, increases in alanine amino transaminase only above the upper limit of normal were not associated with increased 1-year mortality.
Postoperative increases in aspartate amino transaminase only and increases in both aspartate amino transaminase and alanine amino transaminase greater than twice the upper limit of normal were associated with increased 1-year mortality in patients undergoing coronary artery bypass graft.
评估冠状动脉旁路移植术后血清氨基转移酶升高对患者1年死亡率的预后影响。
回顾性分析。
一家三级医疗大学医院。
总共1950例行冠状动脉旁路移植术的患者。
无。
计算天冬氨酸氨基转移酶（AST）和丙氨酸氨基转移酶（ALT）比值，即术后第1个5天内AST和ALT的峰值与其各自正常上限值的比值。在单变量分析中，当同时考虑AST和ALT比值时，发现比值为2.0是能够检测到1年死亡率差异的最小值。多变量分析显示，AST比值>2.0与1年死亡率增加相关（风险比[HR]2.68，95%置信区间[CI]1.42 - 5.05，P = 0.002），并且AST和ALT比值均>2.0也与1年死亡率增加相关（HR 3.90，95% CI 1.87 - 8.14，P < 0.001）。然而，仅ALT升高超过正常上限与1年死亡率增加无关。
在接受冠状动脉旁路移植术的患者中，仅术后AST升高以及AST和ALT均升高超过正常上限两倍与1年死亡率增加相关。
