title: Antithrombin III is associated with acute liver failure in patients with end-stage heart failure undergoing mechanical circulatory support.
abstract: There are few data on the role of liver dysfunction in patients with end-stage heart failure supported by mechanical circulatory support. The aim of our study was to investigate predictors for acute liver failure in patients with end-stage heart failure undergoing mechanical circulatory support.
  
  
  
  A consecutive 164 patients with heart failure with New York Heart Association class IV undergoing mechanical circulatory support were investigated for acute liver failure using the King's College criteria. Clinical characteristics of heart failure together with hemodynamic and laboratory values were analyzed by logistic regression.
  
  
  
  A total of 45 patients (27.4%) with heart failure developed subsequent acute liver failure with a hospital mortality of 88.9%. Duration of heart failure, cause, cardiopulmonary resuscitation, use of vasopressors, central venous pressure, pulmonary capillary wedge pressure, pulmonary pulsatility index, cardiac index, and transaminases were not significantly associated with acute liver failure. Repeated decompensation, atrial fibrillation (P < .001) and the use of inotropes (P = .007), mean arterial (P = .005) and pulmonary pressures (P = .042), cholinesterase, international normalized ratio, bilirubin, lactate, and pH (P < .001) were predictive of acute liver failure in univariate analysis only. In multivariable analysis, decreased antithrombin III was the strongest single measurement indicating acute liver failure (relative risk per %, 0.84; 95% confidence interval, 0.77-0.93; P = .001) and remained an independent predictor when adjustment for the Model for End-Stage Liver Disease score was performed (relative risk per %, 0.89; 95% confidence interval, 0.80-0.99; P = .031). Antithrombin III less than 59.5% was identified as a cutoff value to predict acute liver failure with a corresponding sensitivity of 81% and specificity of 87%.
  
  
  
  In addition to the Model for End-Stage Liver Disease score, decreased antithrombin III activity tends to be superior in predicting acute liver failure compared with traditionally thought predictors. Antithrombin III measurement may help to identify patients more precisely who are developing acute liver failure during mechanical circulatory support.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Judith
authors.initials: J
authors.lastname: Hoefer
authors.affiliation: Department of Medical Statistics, Informatics, and Health Economics, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Hanno
authors.initials: H
authors.lastname: Ulmer
authors.affiliation: Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Juliane
authors.initials: J
authors.lastname: Kilo
authors.affiliation: Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Raimund
authors.initials: R
authors.lastname: Margreiter
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Grimm
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Peter
authors.initials: P
authors.lastname: Mair
authors.affiliation: Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria. Electronic address: elfriede.ruttmann@i-med.ac.at.
authors.forename: Elfriede
authors.initials: E
authors.lastname: Ruttmann
mesh_terms: D000328:Adult; D000368:Aged; D000990:Antithrombin III / Q000378:metabolism*; D015415:Biomarkers / Q000097:blood; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D017114:Liver Failure, Acute / Q000097:blood* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000097:blood / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; C542513:SERPINC1 protein, human; D000990:Antithrombin III
keywords: acute liver failure; cardiogenic shock; extracorporeal membrane oxygenation; mechanical circulatory support