Low serum albumin and advanced age predict early mortality in Asian patients with extreme elevations of serum aminotransferases

Abstract

Background/Aim

Extreme elevations of serum aminotransferases (EESAT) reflect severe hepatic injury and are associated with poor outcome. This study aims to evaluate the prevalence, etiology and clinical outcome of EESAT in Asian patients and to identify predictors of early mortality.

Methods

Case records of patients admitted to a large tertiary hospital with EESAT (defined as at least one ALT and/or AST reading above 3000 U/L) over a 1-year period were retrospectively analyzed for prevalence, etiology and clinical outcome. The primary outcome was 28-day mortality (defined as death occurring within 28 days of the occurrence of EESAT). Logistic regression was performed to identify independent predictors of early mortality.

Results

One hundred and one patients fulfilled criteria for EESAT, providing a prevalence of 1.4 per 1000 admissions. Mean age was 57.4±18.0 years with 63% males. Etiologies of EESAT were hypoxic hepatitis (74%), viral hepatitis (21%), rhabdomyolysis (3%), drug-induced hepatitis (1%) and choledocholithiasis (1%). The 28-day mortality of EESAT was 53.5%. EESAT due to hypoxic hepatitis was associated with high mortality (71%) whereas mortality risk was low in EESAT from viral hepatitis (9.5%). Serum albumin<28g/L (HR 5.8, 95% CI 1.4-23.6) and age>55 years (HR 4.8, 95% CI 1.3-17.9) were independent predictors of mortality.

Conclusion

The main etiology of EESAT in Asians is hypoxic hepatitis, which carries a high mortality. EESAT due to viral hepatitis is common in Asians and is associated with good outcome. Low serum albumin and advanced age are independent predictors of early mortality in EESAT.

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