Abstract 749 Prognostic Value of the AST/ALT Ratio versus Serum Bilirubin in Patients with Cardiogenic Shock

Objective: This study investigates the prognostic value of the aspartate to alanine aminotransferase ratio (i.e., AST/ALT ratio) and serum bilirubin in patients with cardiogenic shock (CS).

Background: Despite ongoing improvements regarding the treatment of CS patients, invasive care unit (ICU) mortality in CS patients remains unacceptably high. Limited data regarding the prognostic value of the AST/ALT ratio and serum bilirubin in patients suffering from CS is available.

Methods: Consecutive patients with CS from 2019 to 2021 were included. Blood samples were retrieved from day of disease onset (day 1), day 2, 3, 4 and 8. The prognostic value of the AST/ALT ratio and serum bilirubin was tested for 30-day all-cause mortality. Statistical analyses included univariable t-tests, Spearman´s correlations, Kaplan-Meier analyses, as well as multivariable Cox proportional regression analyses.

Results: 157 CS patients were included with an overall rate of all-cause mortality at 30 days of 51%. The median AST/ALT ratio on day 1 was 1.4 and the median serum bilirubin was 0.63 mg/dL. No association of the baseline AST/ALT ratio (HR = 0.965; 95% CI 0.833 – 1.118; p = 0.634) and serum bilirubin (HR = 0.987; 95% CI 0.828 – 1.175; p = 0.879) with the risk of 30-day all-cause mortality was found. In contrast, the AST/ALT ratio on day 3 was associated with the risk of 30-day all-cause mortality (HR = 1.181; 95% CI 1.031 – 1.352; p = 0.017), which was still evident after multivariable adjustment (HR = 1.185; 95% CI 1.032 – 1.362; p = 0.016).

Conclusion: The AST/ALT ratio during course of ICU hospitalization from day 3 – but not the baseline AST/ALT ratio and serum bilirubin – was associated with an increased risk of 30-day all-cause mortality in CS patients.

Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w
Prognostic Value of the AST/ALT Ratio versus Serum Bilirubin in Patients with Cardiogenic Shock
T. Schupp¹, J. Rusnak¹, K. J. Weidner¹, M. Ruka², S. Egner-Walter¹, J. Dudda¹, J. Forner¹, T. Bertsch³, K. A. Mashayekhi⁴, M. Ayoub⁵, I. Akin¹, M. Behnes¹
¹I. Medizinische Klinik, Universitätsklinikum Mannheim, Mannheim; ²Medizinische Klinik II, Universitätsklinikum Mannheim, Mannheim; ³Institut für klinische Chemie und Laboratoriumsmedizin und Transfusionsmedizin, Klinikum Nürnberg Nord, Nürnberg; ⁴Innere Medizin und Kardiologie, MediClin Herzzentrum Lahr/Baden, Lahr/Schwarzwald; ⁵Allgemeine und Interventionelle Kardiologie/Angiologie, Herz- und Diabeteszentrum NRW, Bad Oeynhausen;
Objective: This study investigates the prognostic value of the aspartate to alanine aminotransferase ratio (i.e., AST/ALT ratio) and serum bilirubin in patients with cardiogenic shock (CS). Background: Despite ongoing improvements regarding the treatment of CS patients, invasive care unit (ICU) mortality in CS patients remains unacceptably high. Limited data regarding the prognostic value of the AST/ALT ratio and serum bilirubin in patients suffering from CS is available. Methods: Consecutive patients with CS from 2019 to 2021 were included. Blood samples were retrieved from day of disease onset (day 1), day 2, 3, 4 and 8. The prognostic value of the AST/ALT ratio and serum bilirubin was tested for 30-day all-cause mortality. Statistical analyses included univariable t-tests, Spearman´s correlations, Kaplan-Meier analyses, as well as multivariable Cox proportional regression analyses. Results: 157 CS patients were included with an overall rate of all-cause mortality at 30 days of 51%. The median AST/ALT ratio on day 1 was 1.4 and the median serum bilirubin was 0.63 mg/dL. No association of the baseline AST/ALT ratio (HR = 0.965; 95% CI 0.833 – 1.118; p = 0.634) and serum bilirubin (HR = 0.987; 95% CI 0.828 – 1.175; p = 0.879) with the risk of 30-day all-cause mortality was found. In contrast, the AST/ALT ratio on day 3 was associated with the risk of 30-day all-cause mortality (HR = 1.181; 95% CI 1.031 – 1.352; p = 0.017), which was still evident after multivariable adjustment (HR = 1.185; 95% CI 1.032 – 1.362; p = 0.016). Conclusion: The AST/ALT ratio during course of ICU hospitalization from day 3 – but not the baseline AST/ALT ratio and serum bilirubin – was associated with an increased risk of 30-day all-cause mortality in CS patients.
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