Table 3.
Associations between liver chemistries and outcomes
|
In-hospital mortality
|
In-hospital mortality or need for mechanical ventilation
|
|||||||
|
|
Unadjusted analysis-HR (95%CI)
|
P
value
|
Adjusted analysis1-HR (95%CI)
|
P
value
|
Unadjusted analysis-HR (95%CI)
|
P
value
|
Adjusted analysis1-HR (95%CI)
|
P
value
|
| AST | ||||||||
| Normal | Ref. | Ref. | Ref. | Ref. | ||||
| > 1 to ≤ 4 × ULN | 1.29 (1.17-1.42) | < 0.001 | 1.65 (1.47-1.85) | < 0.001 | 1.29 (1.13-1.46) | < 0.001 | 1.73 (1.47-2.04) | < 0.001 |
| > 4 to ≤ 10 × ULN | 1.66 (1.38-1.99) | < 0.001 | 1.69 (1.33-2.14) | < 0.001 | 1.67 (1.27-2.20) | < 0.001 | 2.09 (1.42-3.07) | < 0.001 |
| > 10 × ULN | 3.50 (2.56-4.78) | < 0.001 | 2.64 (1.73-4.04) | < 0.001 | 3.89 (2.48-6.10) | < 0.001 | 3.38 (1.78-6.40) | < 0.001 |
| ALT | ||||||||
| Normal | Ref. | Ref. | Ref. | Ref. | ||||
| > 1 to ≤ 4 × ULN | 0.84 (0.77-0.91) | < 0.001 | 1.21 (1.09-1.34) | < 0.001 | 0.72 (0.63-0.81) | < 0.001 | 1.20 (1.02-1.40) | 0.02 |
| > 4 to ≤ 10 × ULN | 0.88 (0.71-1.09) | 0.24 | 1.22 (0.93-1.61) | 0.15 | 0.79 (0.57-1.09) | 0.15 | 1.40 (0.87-2.26) | 0.16 |
| > 10 × ULN | 1.71 (1.20-2.45) | 0.003 | 1.34 (0.81-2.22) | 0.26 | 1.42 (0.80-2.51) | 0.23 | 1.36 (0.58-3.19) | 0.48 |
| Alkaline phosphatase | ||||||||
| Normal | Ref. | Ref. | Ref. | Ref. | ||||
| Elevated | 1.27 (1.14-1.43) | < 0.001 | 1.29 (1.12-1.48) | < 0.001 | 1.19 (1.01-1.42) | 0.04 | 1.39 (1.12-1.72) | 0.003 |
| Bilirubin | ||||||||
| Normal | Ref. | Ref. | Ref. | Ref. | ||||
| Elevated | 1.55 (1.32-1.82) | < 0.001 | 1.12 (0.92-1.37) | 0.27 | 1.69 (1.34-2.13) | < 0.001 | 0.96 (0.71-1.30) | 0.79 |
| AST:ALT ratio | ||||||||
| ≤ 1 | Ref. | Ref. | Ref. | Ref. | ||||
| > 1 | 2.08 (1.82-2.37) | < 0.001 | 1.72 (1.46-2.02) | < 0.001 | 2.61 (2.13-3.19) | < 0.001 | 1.84 (1.41-2.40) | < 0.001 |
| Pattern of liver injury2 | ||||||||
| Normal or non-severe | Ref. | Ref. | Ref. | Ref. | ||||
| Hepatocellular | 0.93 (0.80-1.09) | 0.39 | 0.90 (0.74-1.11) | 0.33 | 0.84 (0.66-1.07) | 0.15 | 1.18 (0.85-1.65) | 0.33 |
| Mixed | 1.14 (0.74-1.75) | 0.56 | 1.06 (0.65-1.73) | 0.82 | 1.00 (0.52-1.93) | 0.99 | 1.02 (0.44-2.37) | 0.96 |
| Cholestatic | 1.17 (0.85-1.61) | 0.33 | 1.57 (1.07-2.28) | 0.02 | 1.25 (0.81-1.93) | 0.31 | 2.05 (1.17-3.58) | 0.01 |
Adjusted for age (time-varying), sex (time-varying), race (time-varying), ethnicity, and comorbidities (obesity, hypertension, diabetes, coronary artery disease, chronic kidney disease, end-stage renal disease, chronic obstructive pulmonary disease, heart failure, and cancer).
Defined as: Normal or non-severe [alanine aminotransferase (ALT) ≤ 3 × ULN and alkaline phosphatase ≤ 2 × upper limit of normal (ULN)], hepatocellular (ALT > 3 × ULN and alkaline phosphatase ≤ 2 × ULN), mixed (ALT > 3 × ULN and alkaline phosphatase > 2 × ULN), and cholestatic (ALT ≤ 3 × ULN and alkaline phosphatase > 2 × ULN).
AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; CI: Confidence interval; HR: Hazard ratio; ULN: Upper limit of normal.