title: Hypoxic hepatitis in survivors of out-of-hospital cardiac arrest.
abstract: BACKGROUND
  Hypoxic hepatitis (HH) is commonly observed in out-of-hospital cardiac arrest (OHCA) survivors. The objective of this study was to investigate the incidence, clinical courses, and outcomes of as well as predisposing factors for HH in OHCA survivors.
  
  
  METHODS
  The study was based on a registry of cardiac arrest cases from 2009 to 2012 at a tertiary university hospital. We assessed patients' serum aminotransferase levels on return of spontaneous circulation (ROSC) and at 6, 12, 24, 48, and 72 hours postarrest. Hypoxic hepatitis was defined as a rapid increase in serum aminotransferase that reached at least 20 times the upper limit of normal. The patients were classified into 2 groups: the HH group and the non-HH group; we then analyzed the outcomes of the HH group. Independent predisposing factors to HH in this cohort were identified.
  
  
  RESULTS
  Of a total of 535 OHCA cases, 148 patients were enrolled in this study. Hypoxic hepatitis was identified in 13.5% (n = 20) of them. Serum aminotransferase rapidly increased in the first day after return of spontaneous circulation. Of the patients who developed HH, 5 (25%) survived to hospital discharge, and none of these individuals had good neurologic outcomes (Glasgow-Pittsburgh cerebral performance categories 1 and 2). Using multivariate logistic regression, we found that the no flow time was independent predictors of HH (odds ratio, 1.085 [95% confidence interval, 1.027-1.146]; P = .003).
  
  
  CONCLUSIONS
  Hypoxic hepatitis occurred frequently in survivors of OHCA. The no flow time was an independent risk factor for HH, which was significantly related to death and poor neurologic outcomes.
authors.affiliation: Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Oh
authors.affiliation: Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea. Electronic address: hanjoon@catholic.ac.kr.
authors.forename: Han Joon
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
authors.forename: Kyu Nam
authors.initials: KN
authors.lastname: Park
authors.affiliation: Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
authors.forename: Soo Hyun
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
authors.forename: Young Min
authors.initials: YM
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
authors.forename: Chun Song
authors.initials: CS
authors.lastname: Youn
authors.affiliation: Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
authors.forename: Jee Yong
authors.initials: JY
authors.lastname: Lim
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D005260:Female; D006505:Hepatitis / Q000201:enzymology / Q000453:epidemiology*; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000150:complications* / Q000401:mortality; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D017741:Survivors
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase