病因和明显升高的转氨酶峰值与死亡率的关系：一项多中心研究。

Association of the etiology and peak level of markedly elevated aminotransferases with mortality: a multicenter study.

机构信息

Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea.

Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea.

出版信息

Hepatol Commun. 2023 Apr 26;7(5). doi: 10.1097/HC9.0000000000000149. eCollection 2023 May 1.

DOI:10.1097/HC9.0000000000000149

PMID:37102763

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10146537/

Abstract

BACKGROUND

Markedly elevated aminotransferase levels are commonly encountered among hospitalized patients. However, data regarding the trajectory of enzyme elevation and disease-specific prognosis are limited.

METHODS

This study included 3237 patients with at least one episode of aspartate aminotransferase or alanine aminotransferase level being higher than 400 U/L between January 2010 and December 2019 at 2 centers. Patients were classified into 5 groups comprising 13 diseases according to etiology. Factors associated with 30-day mortality were evaluated using a logistic regression analysis.

RESULTS

The most common disease leading to markedly elevated aminotransferase level was ischemic hepatitis (33.7%), followed by pancreatobiliary disease (19.9%), DILI (12.0%), malignancy (10.8%), and viral hepatitis (7.0%). The 30-day all-cause mortality rate was 21.6%. The mortality rate for patients from the pancreatobiliary, hepatocellular, extrahepatic, malignancy, and ischemic hepatitis groups was 1.7%, 3.2%, 13.8%, 39.9%, and 44.2%, respectively. Age, etiology, and peak aminotransferase levels were independently associated with 30-day mortality.

CONCLUSIONS

In patients with markedly elevated liver enzymes, the etiology and peak AST level are significantly associated with mortality.

摘要

背景

住院患者常出现明显的转氨酶升高。然而，有关酶升高的轨迹和特定疾病预后的数据有限。

方法

本研究纳入了 2010 年 1 月至 2019 年 12 月期间在 2 家中心至少有一次天门冬氨酸转氨酶或丙氨酸转氨酶水平高于 400U/L 的 3237 例患者。根据病因将患者分为 5 组，包括 13 种疾病。使用 logistic 回归分析评估与 30 天死亡率相关的因素。

结果

导致明显转氨酶升高的最常见疾病是缺血性肝炎（33.7%），其次是胆胰疾病（19.9%）、药物性肝损伤（12.0%）、恶性肿瘤（10.8%）和病毒性肝炎（7.0%）。30 天全因死亡率为 21.6%。来自胆胰、肝细胞、肝外、恶性肿瘤和缺血性肝炎组的患者死亡率分别为 1.7%、3.2%、13.8%、39.9%和 44.2%。年龄、病因和转氨酶峰值与 30 天死亡率独立相关。