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Serum albumin prognostic of mortality in severe hypoxic hepatitis

Jairia Dela Cruz
07 Oct 2017

Serum albumin appears to be useful in predicting early mortality in Asian patients with severe hypoxic hepatitis, with low baseline levels entailing a fivefold increase in risk of death, as shown in a Singapore study.

“Our findings are clinically important because it provides the clinician with a simple way to identify patients with severe hypoxic hepatitis who are at highest risk of death,” according to a team of investigators from the Singapore General Hospital.

Using computerized patient records, the team identified 75 cases of severe hypoxic hepatitis out of 71,380 hospital admissions over 1 year. This translated into an incidence rate of 1.05 cases per 1,000 admissions. [World J Hepatol 2017;9:959-966]

Serum albumin, measured at the onset of the condition, emerged as the sole independent predictive factor for early inpatient mortality. A baseline level of <28 g/L accurately predicted mortality with a sensitivity of 75 percent, specificity of 64 percent and positive predictive value of 83 percent, as demonstrated in the area under the receiver operating characteristic curve.

Compared with severe hypoxic hepatitis patients with baseline serum albumin >28 g/L, those who had <28 g/L had a fivefold increased risk of early death (odds ratio, 5.39; 95 percent CI, 1.85 to 15.71) and 85-percent lower survival (mean duration, 3 vs 21 days; p=0.015).

The median age of the cohort was 65 years, and 57.3 percent were men. Of the 75 patients, 53 (71 percent) died during the hospitalization. Most deaths associated with severe hypoxic hepatitis were attributed to acute myocardial infarction and sepsis.

Based on the present data, serum albumin is a useful clinical marker for early prognostication of severe hypoxic hepatitis patients at high risk of death, the investigators said. “Patients with severe hypoxic hepatitis with a baseline serum albumin level <28 g/L can be fast-tracked for ICU care and early vasopressor therapy to maintain adequate central perfusion.”

“Of interest is whether timely intervention with intravenous albumin will result in a reduction of mortality in patients with severe hypoxic hepatitis,” they added.

Other than the discussed, the study also shows that hypoxic hepatitis is an important cause of liver injury that, while uncommon, is associated with poor clinical outcomes and a high mortality rate. Moreover, the clinical profile and mortality rate in Asians are consistent with that reported in Western studies. [Am J Med 2015;128:1314-1321; Liver Int 2012;32:1039-1052; Gastroenterol Hepatol 2005;28:15-19]

However, as the investigators noted, the findings are limited to patients with severe hypoxic hepatitis and may not be applicable to milder degrees of the condition because the study was limited to a single centre and focused on patients with severe elevation of serum transaminases beyond 100 times the upper limit of normal.

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