Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
Department of Medical Biotechnologies, Anesthesia and Intensive Care Unit, University of Siena, Siena, Italy.
PLoS One. 2018 Nov 5;13(11):e0206655. doi: 10.1371/journal.pone.0206655. eCollection 2018.
Few data are available regarding hypoxic hepatitis (HH) and acute liver failure (ALF) in patients resuscitated from cardiac arrest (CA). The aim of this study was to describe the occurrence of these complications and their association with outcome. All adult patients admitted to the Department of Intensive Care following CA were considered for inclusion in this retrospective study. Exclusion criteria were early death (<24 hours) or missing biological data. We retrieved data concerning CA characteristics and markers of liver function. ALF was defined as a bilirubin >1.2 mg/dL and an international normalized ratio ≥1.5. HH was defined as an aminotransferase level >1000 IU/L. Neurological outcome was assessed at 3 months and an unfavourable neurological outcome was defined as a Cerebral Performance Categories (CPC) score of 3-5. A total of 374 patients (age 62 [52-74] years; 242 male) were included. ALF developed in 208 patients (56%) and HH in 27 (7%); 24 patients developed both conditions. Patients with HH had higher mortality (89% vs. 51% vs. 45%, respectively) and greater rates of unfavourable neurological outcome (93% vs. 60% vs. 59%, respectively) compared to those with ALF without HH (n = 184) and those without ALF or HH (n = 163; p = 0.03). Unwitnessed arrest, non-shockable initial rhythm, lack of bystander cardiopulmonary resuscitation, high adrenaline doses and the development of acute kidney injury were independent predictors of unfavourable neurological outcome; HH (OR: 16.276 [95% CIs: 2.625-81.345; p = 0.003), but not ALF, was also a significant risk-factor for unfavourable outcome. Although ALF occurs frequently after CA, HH is a rare complication. Only HH is significantly associated with poor neurological outcome in this setting.
关于心脏骤停后复苏患者的缺氧性肝炎(HH)和急性肝衰竭(ALF),相关数据较少。本研究旨在描述这些并发症的发生情况及其与预后的关系。所有因心脏骤停后入住重症监护病房的成年患者均被纳入本回顾性研究。排除标准为早期死亡(<24 小时)或缺失生物数据。我们检索了有关心脏骤停特征和肝功能标志物的数据。ALF 的定义为胆红素>1.2mg/dL 和国际标准化比值≥1.5。HH 的定义为转氨酶水平>1000IU/L。神经功能预后在 3 个月时进行评估,不良神经功能预后定义为脑功能分类(CPC)评分 3-5 分。共纳入 374 例患者(年龄 62[52-74]岁;242 例男性)。208 例(56%)患者发生 ALF,27 例(7%)患者发生 HH;24 例患者同时发生两种情况。HH 患者死亡率更高(89%比 51%比 45%),不良神经功能预后发生率更高(93%比 60%比 59%),与无 HH 的 ALF 患者(n=184)和无 ALF 或 HH 的患者(n=163)相比,差异均有统计学意义(p=0.03)。未目击的骤停、初始非可除颤节律、缺乏旁观者心肺复苏、高肾上腺素剂量和急性肾损伤的发生是不良神经功能预后的独立预测因素;HH(OR:16.276[95%置信区间:2.625-81.345;p=0.003),而不是 ALF,也是不良预后的显著危险因素。尽管心脏骤停后 ALF 常发生,但 HH 是一种罕见的并发症。在这种情况下,只有 HH 与不良神经功能预后显著相关。