A retrospective cross-sectional study for predicting 72-h mortality in patients with serum aspartate aminotransferase levels ≥ 3000 U/L

Abstract

Risk factors associated with 72-h mortality in patients with extremely high serum aspartate aminotransferase levels (AST; ≥ 3000 U/L) are unknown. This single-centre, retrospective, case-controlled, cross-sectional study obtained data from medical records of adult patients treated at Saitama Medical Center, Japan, from 2005 to 2019. We conducted a multivariate logistic after adjusting for age, sex, height, weight, body mass index, Brinkman Index, vital signs, biochemical values, updated Charlson Comorbidity Index (CCI) score, CCI components, and underlying causes. A logistic regression model with selected validity risks and higher C-statistic for predicting 72-h mortality was established. During the 15-year period, 428 patients (133 non-survivors and 295 survivors [cases and controls by survival < 72 and ≥ 72 h, respectively]) with AST levels ≥ 3000 U/L were identified. The 72-h mortality rate was 133/428 (31.1%). The model used for predicting 72-h mortality through the assessment of alkaline phosphatase, creatine kinase, serum sodium, potassium, and phosphorus levels had a C-statistic value of 0.852 (sensitivity and specificity, 76.6%). The main independent risk factors associated with 72-h mortality among patients with AST levels ≥ 3000 U/L included higher serum values of alkaline phosphatase, creatine kinase, serum sodium, potassium, and phosphorus.

Correlation between the 72-hour fatality ratios and out-of-hospital cardiac arrest ratios in patients with extremely high outlier values of 57 laboratory test items: A single-center retrospective inception cohort study

“…The 72-hour mortality rate in patients with AST levels ≥ 3000 U/L was 31.1%, and high levels of ALP, CK, Na, K, and inorganic phosphorus were predictive indices. [ 7 ] The 72-hour fatality ratio in patients with CRP levels ≥ 40 mg/dL was 16.0%, and old age, low albumin level, high inorganic phosphorus level, and complications of cardiovascular disease were predictive indicators. [ 8 ] The 72-hour fatality ratio in patients with RPG levels ≥ 500 mg/dL was 4.6%, and low albumin level, high CK level, and the presence of malignancy were predictive indicators.…”

“…The 72-hour mortality rate in patients with AST levels ≥ 3000 U/L was 31.1%, and high levels of ALP, CK, Na, K, and inorganic phosphorus were predictive indices. [7] The…”

“…JSLM2018 [12] Panic data and critical values N/A ✔ ✔ ✔ ✔ ✔ ✔ Hamano et al [13] Advanced cancer 7-90 d ✔ ✔ ✔ ✔ Chen et al [14] Advanced cancer 7 d Cheng et al [15] Metastatic or advanced cancer 14 d ✔ ✔ Onishi et al [16] Terminal illness 14 d ✔ ✔ ✔ ✔ Niki et al [17] Terminal cancer 2 or 3 wk ✔ ✔ ✔ ✔ Forrest et al [18] Inoperable non-small-cell lung cancer Survival mo ✔ Kawai et al [19] Terminally ill cancer 30 d ✔ ✔ Tyler et al [20] Intensive care unit Death in the ICU ✔ ✔ ✔ Saito et al [7] AST more than 3000 U/L 72 h ✔ ✔ Saito et al [8] CRP more than 40 mg/dL 72 h Watanabe et al [9] RPG more than 500 mg/dL 72 h ✔ "A" indicates laboratory test items with 72-h mortality rates that were above the upper limit of the linear confidence region of the regression line and higher rates than the out-of-hospital cardiac arrest rate. AST = aspartate aminotransferase, BUN = blood urea nitrogen, CK = creatine kinase, CRP = C-reactive protein, HCO 3 − = bicarbonate ion, LD = lactic dehydrogenase, N/A = not applicable, Na = sodium, T-Bil = total bilirubin.…”

“…AST = aspartate aminotransferase, BUN = blood urea nitrogen, CK = creatine kinase, CRP = C-reactive protein, HCO 3 − = bicarbonate ion, LD = lactic dehydrogenase, N/A = not applicable, Na = sodium, T-Bil = total bilirubin. JSLM2018 [12] ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ Hamano et al [13] ✔ ✔ ✔ ✔ ✔ ✔ Chen et al [14] ✔ ✔ ✔ ✔ Cheng et al [15] ✔ ✔ ✔ Onishi et al [16] ✔ ✔ Niki et al [17] ✔ ✔ Forrest et al [18] ✔ Kawai et al [19] ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ Tyler et al [20] ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ Saito et al [7] ✔ ✔ ✔ Saito et al [8] ✔ ✔ Watanabe et al [9] ✔ "B" indicates laboratory test items with 72-h mortality rates that were below the lower limit of the linear confidence region of the regression line and lower rates than the out-of-hospital cardiac arrest rate. "C" indicates selected item that were classified as neither "A" nor "B" in this study.…”

“…[ 3 ] However, the nature of extremely high outlier values of various laboratory tests (panic values or not) and the role of these values in the actual prognosis have not been sufficiently examined. Several studies have identified the following as the predictors of 72-hour mortality for patients in intensive care units (ICUs), [ 4 ] after emergency department visits, [ 5 ] and those with trauma [ 6 ] : aspartate aminotransferase (AST) level ≥ 3000 U/L, [ 7 ] C-reactive protein (CRP) level ≥ 40 mg/dL, [ 8 ] and random plasma glucose level ≥ 500 mg/dL. [ 9 ] In other words, to the best of our knowledge, no previous studies have analyzed the association between each extremely high outlier value of laboratory test items and short-term prognosis or out-of-hospital cardiac arrest (OHCA) from a cross-disease perspective.…”