title: Hypoxic hepatitis after out-of-hospital cardiac arrest: Incidence, determinants and prognosis.
abstract: Hypoxic hepatitis (HH) may complicate the course of resuscitated out-of-hospital cardiac arrest (OHCA) patients admitted in intensive care unit (ICU). Aims of this study were to assess the prevalence of HH, and to describe the factors associated with HH occurrence and outcome.
  
  
  
  We conducted an observational study over a 6-year period (2009-2014) in a cardiac arrest center. All non-traumatic OHCA patients admitted in the ICU after return of spontaneous circulation (ROSC) and who survived more than 24h were included. HH was defined as an elevation of alanine aminotransferase over 20 times the upper limit of normal during the first 72h after OHCA. Factors associated with HH and ICU mortality were picked up by multivariate logistic regression.
  
  
  
  Among the 632 OHCA patients included in the study, HH was observed in 72 patients (11.4% (95% CI: 9.0%, 14.1%)). In multivariate analysis, time from collapse to ROSC [OR 1.02 per additional minute; 95% CI (1.00, 1.04); p=0.01], male gender [OR 0.53; 95% CI (0.29, 0.95); p=0.03] and initial shockable rhythm [OR 0.35; 95% CI (0.19, 0.65); p<0.01] were associated with HH occurrence. After adjustment for confounding factors, HH was associated with ICU mortality [OR 4.39; 95% CI (1.71, 11.26); p<0.01] and this association persisted even if occurrence of a post-CA shock was considered in the statistical model [OR 3.63; 95% CI (1.39, 9.48); p=0.01].
  
  
  
  HH is not a rare complication after OHCA. This complication is mainly triggered by the duration of resuscitation and is associated with increased ICU mortality.
authors.affiliation: Medical Intensive Care Unit, Cochin University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France. Electronic address: benoit.champigneulle@aphp.fr.
authors.forename: B
authors.initials: B
authors.lastname: Champigneulle
authors.affiliation: Medical Intensive Care Unit, Cochin University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; INSERM U970 Sudden Death Expertise Center, Paris Cardiovascular Research Center, Paris, France.
authors.forename: G
authors.initials: G
authors.lastname: Geri
authors.affiliation: Medical Intensive Care Unit, Cochin University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; INSERM U970 Sudden Death Expertise Center, Paris Cardiovascular Research Center, Paris, France.
authors.forename: W
authors.initials: W
authors.lastname: Bougouin
authors.affiliation: Paris Descartes University, Sorbonne Paris Cité, Paris, France; Emergency Department, Cochin University Hospital, AP-HP, Paris, France; INSERM U970 Sudden Death Expertise Center, Paris Cardiovascular Research Center, Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Dumas
authors.affiliation: Medical Intensive Care Unit, Cochin University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Arnaout
authors.affiliation: Medical Intensive Care Unit, Cochin University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.
authors.forename: L
authors.initials: L
authors.lastname: Zafrani
authors.affiliation: Medical Intensive Care Unit, Cochin University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Pène
authors.affiliation: Medical Intensive Care Unit, Cochin University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France.
authors.forename: J
authors.initials: J
authors.lastname: Charpentier
authors.affiliation: Medical Intensive Care Unit, Cochin University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France.
authors.forename: J P
authors.initials: JP
authors.lastname: Mira
authors.affiliation: Medical Intensive Care Unit, Cochin University Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France; Paris Descartes University, Sorbonne Paris Cité, Paris, France; INSERM U970 Sudden Death Expertise Center, Paris Cardiovascular Research Center, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Cariou
mesh_terms: D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D016887:Cardiopulmonary Resuscitation; D005260:Female; D006505:Hepatitis / Q000150:complications / Q000201:enzymology / Q000453:epidemiology*; D006801:Humans; D007003:Hypoglycemia / Q000150:complications; D000860:Hypoxia / Q000150:complications; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058687:Out-of-Hospital Cardiac Arrest / Q000150:complications* / Q000401:mortality; D013997:Time Factors
chemical_list: D000410:Alanine Transaminase
keywords: Cardiac arrest; Hypoxic hepatitis; Liver failure; Post-cardiac arrest syndrome; Shock liver