Background
Methods
Study cohort and data collection
Statistical analysis
Results
Patient and episode characteristics
Variable | Patients | Variable | Patients | ||||||
---|---|---|---|---|---|---|---|---|---|
Total (n = 1116) | In-hospital 28-day mortality |
P
| Total (n = 1116) | In-hospital 28-day mortality |
P
| ||||
No (n = 614) | Yes (n = 502) | No (n = 614) | Yes (n = 502) | ||||||
Sexa | ASTmaxa | ||||||||
Male | 61.3% (684) | 62.2% (382) | 60.2% (302) | 0.483 | 5–10× ULN | 35.4% (395) | 43.0% (264) | 26.1% (131) | < 0.001 |
Ageb (year) | 66.0 (55.0–74.0) | 63.0 (53.0–73.0) | 68.0 (58.0–76.8) | < 0.001 | 10–20× ULN | 23.4% (261) | 23.6% (145) | 23.1% (116) | 0.985 |
BMIb (kg/m2) | 25.4 (22.9–28.9) | 25.4 (23.0–28.5) | 25.4 (22.9–29.4) | 0.774 | > 20× ULN | 41.2% (460) | 33.4% (205) | 50.8% (255) | < 0.001 |
Causea | Supportive therapyc | ||||||||
Cardiac failure | 49.1% (548) | 52.3% (321) | 45.2% (227) | 0.103 | Ventilationa | 74.9% (836) | 66.4% (408) | 85.3% (428) | < 0.001 |
Septic shock | 29.8% (333) | 25.6% (157) | 35.1% (176) |
0.003
| Medication | ||||
Hypovolemic shock | 9.4% (105) | 9.6% (59) | 9.2% (46) | 0.999 | Inotropic agentsa | 43.2% (482) | 39.3% (241) | 48.0% (241) |
0.003
|
Acute respiratory failure | 6.4% (71) | 7.0% (43) | 5.6% (28) | 0.927 | Vasopressor agentsa | 60.8% (678) | 51.1% (314) | 72.5% (364) | < 0.001 |
Acute on chronic respiratory failure | 3.3% (37) | 3.7% (23) | 2.8% (14) | 0.956 | Dialysisa | 9.5% (106) | 6.8% (42) | 12.7% (64) | < 0.001 |
Pulmonary embolism | 1.4% (16) | 1.1% (7) | 1.8% (9) | 0.945 | IABPa | 17.5% (195) | 19.5% (120) | 14.9% (75) |
0.044
|
Hyperthermia | 0.5% (6) | 0.7% (4) | 0.4% (2) | 0.995 | LOS | ||||
Comorbidities | ICUb (day) | 4.4 (1.2–11.7) | 6.4 (2.7–17.7) | 1.8 (0.4–7.1) | < 0.001 | ||||
Echocardioa | Hospitalb (day) | 12.1 (3.0–28.9) | 25.7 (13.9–48.1) | 2.1 (0.4–8.1) | < 0.001 | ||||
Overall | 0.406 | Duration | |||||||
Normal | 40.0% (446) | 42.0% (258) | 37.5% (188) | – | Episode of HHb (h) | 54.3 (26.4–94.2) | 53.4 (23.9–94.2) | 56.7 (30.7–94.1) | 0.527 |
LV dysfunction | 25.1% (280) | 23.5% (144) | 27.1% (136) | – | Recovery of HHb (h) | 34.7 (14.6–67.2) | 35.5 (14.1–68.0) | 32.6 (16.2–61.4) | 0.393 |
Missing | 22.2% (248) | 22.5% (151) | 23.3% (117) | – | 28-day mortality | ||||
LV and RV dysfunction | 8.0% (89) | 8.0% (49) | 8.0% (40) | – | ICUa | 40.8% (455) | 0.0% (0) | 90.6% (455) | < 0.001 |
RV dysfunction | 4.7% (53) | 5.2% (32) | 4.2% (21) | – | In-hospitala | 45.0% (502) | 0.0% (0) | 100.0% (502) | < 0.001 |
DMa | 18.7% (209) | 17.4% (107) | 20.3% (102) | 0.218 | |||||
Chronic respiratory failurea | 11.4% (127) | 10.7% (66) | 12.2% (61) | 0.287 | |||||
SOI scoresc | |||||||||
APS-IIb | 28.0 (21.0–34.0) | 25.0 (18.0–32.0) | 30.0 (24.0–35.2) |
0.005
| |||||
SAPS-IIb | 66.0 (46.0–81.0) | 54.0 (36.0–71.0) | 76.0 (58.0–89.0) | < 0.001 |
Variable | Patients | Variable | Patients | ||||||
---|---|---|---|---|---|---|---|---|---|
ASTmax subgroup |
P
| ASTmax subgroup |
P
| ||||||
5× ULN–10× ULN (n = 395) | 10× ULN–20× ULN (n = 261) | > 20× ULN (n = 460) | 5× ULN–10× ULN (n = 395) | 10× ULN–20× ULN (n = 261) | > 20× ULN (n = 460) | ||||
Sexa | SOI scoresc | ||||||||
Male | 60.5% (239) | 62.5% (163) | 61.3% (282) | 0.882 | APS-IIb | 24.0 (18.0–31.0) | 26.5 (20.0–32.2) | 32.0 (24.0–37.9) | < 0.001 |
Ageb (year) | 63.0 (45.0–73.5) | 66.0 (56.0–75.0) | 67.0 (55.8–75.0) |
0.014
| SAPS-IIb | 57.0 (36.2–74.0) | 60.0 (41.0–78.2) | 73.0 (56.0–86.5) | < 0.001 |
BMIb (kg/m2) | 25.5 (23.1–28.7) | 25.5 (22.9–29.2) | 25.1 (22.9–28.9) | 0.647 | Supportive therapyc | ||||
Causea | Ventilationa | 71.9% (284) | 72.4% (189) | 78.9% (363) |
0.035
| ||||
Overall | 0.135 | Medication | |||||||
Cardiac failure | 50.6% (200) | 49.8% (130) | 47.4% (218) | – | Inotropic agentsa | 38.5% (152) | 37.9% (99) | 50.2% (231) | < 0.001 |
Septic shock | 29.4% (116) | 26.1% (68) | 32.4% (149) | – | Vasopressor agentsa | 50.9% (201) | 59.4% (155) | 70.0% (322) | < 0.001 |
Hypovolemic shock | 7.6% (30) | 10.3% (27) | 10.4% (48) | – | Dialysisa | 4.8% (19) | 8.4% (22) | 14.1% (65) | < 0.001 |
Acute respiratory failure | 7.1% (28) | 9.2% (24) | 4.1% (19) | – | IABPa | 13.7% (54) | 20.7% (54) | 18.9% (87) |
0.041
|
Acute on chronic respiratory failure | 3.3% (13) | 1.9% (5) | 4.1% (19) | – | LOS | ||||
Pulmonary embolism | 1.5% (6) | 1.5% (4) | 1.3% (6) | – | ICUb (day) | 4.6 (1.6–11.2) | 4.8 (1.4–11.2) | 4.0 (0.7–12.4) | 0.325 |
Hyperthermia | 0.5% (2) | 1.1% (3) | 0.2% (1) | – | Hospitalb (day) | 12.5 (6.5–29.5) | 13.1 (4.1–27.6) | 10.2 (0.9–29.8) | 0.250 |
Comorbidities | Duration | ||||||||
Echocardioa | Episode of HHb (h) | 23.6 (11.4–37.2) | 56.8 (40.5–79.6) | 104.7 (78.1–132.0) | < 0.001 | ||||
Normal | 43.8% (173) | 34.5% (90) | 39.8% (183) | 0.234 | Recovery of HHb (h) | 12.6 (6.1–22.2) | 36.2 (22.7–52.0) | 77.7 (56.6–102.4) | < 0.001 |
LV dysfunction | 20.5% (81) | 27.6% (72) | 27.1% (136) | 0.136 | 28-day mortality | ||||
Missing | 25.3% (100) | 26.8% (70) | 17.0% (78) |
0.008
| ICUa | 29.4% (116) | 38.3% (100) | 52.0% (239) | < 0.001 |
LV and RV dysfunction | 5.8% (23) | 8.4% (22) | 9.6% (44) | 0.452 | In-hospitala | 33.2% (131) | 44.4% (116) | 55.4% (255) | < 0.001 |
RV dysfunction | 4.6% (18) | 2.7% (7) | 6.1% (28) | 0.422 | |||||
DMa | 14.9% (59) | 21.1% (55) | 20.7% (95) | 0.055 | |||||
Chronic respiratory failurea | 12.2% (48) | 10.7% (28) | 11.1% (51) | 0.826 |
Variable | Cause | |||||||
---|---|---|---|---|---|---|---|---|
Cardiac failure (n = 548) | Septic shock (n = 333) | Hypovolemic shock (n = 105) | Acute respiratory failure (n = 71) | Acute on chronic respiratory failure (n = 37) | Pulmonary embolism (n = 16) | Hyperthermia (n = 6) |
P
| |
Sexa | ||||||||
Male | 63.1% (346) | 61.6 (205) | 57.1% (60) | 54.9% (39) | 54.1% (20) | 62.5 (10) | 66.7% (4) | 0.721 |
Ageb (year) | 68.0 (58.0–76.0) | 64.0 (52.0–74.0) | 64.0 (56.0–73.0) | 59.0 (48.5–71.5) | 65.0 (61.0–72.0) | 57.5 (47.5–61.5) | 54.5 (35.8–64.2) |
0.003
|
BMIb (kg/m2) | 25.5 (23.3–28.7) | 25.0 (22.1–29.3) | 26.2 (23.4–28.9) | 24.2 (22.0–27.8) | 24.6 (22.1–27.3) | 27.8 (25.1–31.0) | 27.6 (23.7–29.3) | 0.202 |
Comorbidities | ||||||||
Echocardioa | ||||||||
Normal | 32.7% (179) | 51.1% (170) | 43.8% (46) | 36.6% (26) | 48.6% (18) | 18.8% (3) | 66.7% (4) | < 0.001 |
LV dysf. | 36.5% (200) | 15.9% (53) | 5.7% (6) | 21.1% (15) | 10.8% (4) | 6.2% (1) | 16.7% (1) | < 0.001 |
Missing | 13.3% (73) | 26.1% (87) | 46.7% (49) | 35.2% (25) | 24.3% (9) | 25.0% (4) | 16.7% (1) | < 0.001 |
LV and RV dysf. | 13.0% (71) | 3.3% (11) | 1.0% (1) | 4.2% (3) | 2.7% (1) | 12.5% (2) | 0.0% (0) | < 0.001 |
RV dysf. | 4.6% (25) | 3.6% (12) | 2.9% (3) | 2.8% (2) | 13.5% (5) | 37.5% (6) | 0.0% (0 | < 0.001 |
DMa | 20.8% (114) | 19.2% (64) | 10.5% (11) | 12.7% (9) | 24.3% (9) | 12.5% (2) | 0.0% (0) | 0.103 |
Chronic respiratory failurea | 8.4% (46) | 9.6% (32) | 9.5% (10) | 0.0% (%) | 100.0% (37) | 12.5% (2) | 0.0% (0) | < 0.001 |
SOI scoresc | ||||||||
APS-IIb | 28.0 (23.0–35.0) | 26.0 (21.0–35.0) | 26.0 (18.5–32.5) | 30.0 (28.0–34.0) | 26.5 (24.2–30.8) | 36.5 (36.2–36.8) | 21.5 (19.2–25.0) | 0.590 |
SAPS-IIb | 66.0 (44.0–79.0) | 67.0 (49.0–84.0) | 65.0 (48.0–82.0) | 63.0 (31.0–79.0) | 67.5 (55.0–73.5) | 83.0 (69.2–99.2) | 41.5 (34.0–48.2) | 0.171 |
ASTmaxa | ||||||||
Overall | 0.135 | |||||||
5–10× ULN | 36.5% (200) | 34.8% (116) | 28.6% (30) | 39.4% (28) | 35.1% (13) | 37.5% (6) | 33.3% (2) | – |
10–20× ULN | 23.7% (130) | 20.4% (68) | 25.7% (27) | 33.8% (24) | 13.5% (5) | 25.0% (4) | 50.0% (3) | – |
> 20× ULN | 39.8% (218) | 44.7% (149) | 45.7% (48) | 26.8% (19) | 51.4% (19) | 37.5% (6) | 16.7% (1) | – |
Supportive therapyc | ||||||||
Ventilationa | 79.2% (434) | 73.0% (243) | 70.5% (74) | 60.6% (43) | 64.9 (24) | 75.0% (12) | 100.0% (6) |
0.004
|
Medication | ||||||||
Inotropic agentsa | 63.1% (346) | 26.4% (88) | 21.0% (22) | 12.7% (9) | 21.6% (8) | 43.8% (7) | 33.3% (2) | < 0.001 |
Vasopressor agentsa | 58.6% (321) | 69.1% (230)d | 61.9% (65) | 46.5% (33) | 43.2% (16) | 75.0% (12) | 16.7% (1) | < 0.001 |
Dialysisa | 10.4% (57) | 11.1% (37) | 2.9% (3) | 9.9% (7) | 2.7% (1) | 0.0% (0) | 16.7% (1) | 0.090 |
IABPa | 32.8% (180) | 4.2% (14) | 0.0% (0) | 1.4% (1) | 0.0% (0) | 0.0% (0) | 0.0% (0) | < 0.001 |
LOS | ||||||||
ICUb (day) | 4.6 (1.4–10.5) | 4.7 (0.9–15.8) | 2.6 (0.7–7.8) | 6.3 (2.3–15.0) | 3.2 (1.4–7.8) | 2.2 (0.3–4.1) | 7.7 (6.6–14.2) | 0.135 |
Hospitalb (day) | 11.1 (4.6–25.7) | 12.3 (1.1–37.9) | 11.2 (0.9–28.8) | 14.3 (5.2–30.2) | 20.6 (7.6–27.7) | 5.4 (0.3–19.4) | 43.4 (10.2–97.4) |
0.037
|
Duration | ||||||||
Episode of HHb (h) | 50.6 (24.9–99.3) | 54.5 (25.1–87.2) | 69.4 (36.8–89.5) | 71.3 (39.0–90.0) | 28.4 (15.1–77.2) | 69.5 (28.0–139.0) | 54.6 (35.4–74.0) | 0.137 |
Recovery of HHb (h) | 33.8 (3.4–67.5) | 34.3 (14.3–60.9) | 41.7 (21.1–65.1) | 31.0 (16.2–62.1) | 39.9 (11.6–89.3) | 35.3 (10.5–65.4) | 29.6 (21.7–43.3) | 0.810 |
28-day mortality | ||||||||
ICUa | 37.8% (207) | 48.3% (161) | 40.0% (42) | 33.8% (24) | 27.0% (10) | 56.2% (9) | 33.3% (2) |
0.012
|
In-hospitala | 41.4% (227) | 52.9% (176) | 43.8% (46) | 39.4% (28) | 37.8% (14) | 56.2% (9) | 33.3% (2) |
0.029
|
Trend of liver tests
Variable | At start of HH | At T-ASTmax |
---|---|---|
AST (U/L) | 185.0 (155.0–185.0) | 521.2 (269.1–1581.6) |
ALT (U/L) | 120.8 (70.1–193.5) | 317.0 (143.5–924.5) |
LDH (U/L) | 691.8 (465.8–1025.7) | 1106.4 (624.8–2602.8) |
Bilirubin (mg/dL) | 0.8 (0.5–1.6) | 1.0 (0.6–2.0) |
GGT (U/L) | 73.1 (36.2–160.4) | 82.5 (41.7–167.0) |
AP (U/L) | 88.2 (61.8–150.9) | 94.0 (62.9–167.0) |
Lipase (U/L) | 32.4 (18.9–58.9) | 33.5 (18.5–66.4) |
INR | 1.4 (1.2–1.8) | 1.6 (1.3–2.2) |
PC (103/µL) | 165.7 (103.6–241.0) | 146.0 (79.5–218.0) |
WBC (103/µL) | 12.5 (8.8–17.6) | 13.2 (9.0–18.5) |
Hb (g/dL) | 10.1 (8.8–12.0) | 9.8 (8.6–11.5) |
CK (U/L) | 214.0 (77.2–747.2) | 322.2 (105.1–1102.9) |
Creatinine (mg/dL) | 1.4 (0.9–2.1) | 1.4 (0.9–2.2) |
Urea (mg/dL) | 57.1 (38.9–91.3) | 61.6 (40.6–96.4) |
Lactate (mg/dL) | 31.3 (16.2–62.2) | 27.4 (14.7–56.2) |