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Research
Short-term changes in liver tests predict long-term mortality
  1. Eliana Saffouri1,
  2. Eugénie S Lim2,
  3. Susan W Kim3,
  4. Paul Hakendorf4,
  5. Campbell H Thompson2
  1. 1Department of Gastroenterology, Forth Valley Royal Hospital, NHS Forth Valley, Lambert, Scotland, UK
  2. 2Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia
  3. 3Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, South Australia, Australia
  4. 4Flinders’ Southern Adelaide Clinical School, Flinders University, Adelaide, South Australia, Australia
  1. Correspondence to Dr Eugénie S Lim, Department of Medicine, University of Adelaide, Level 1, Eleanor Harrald Building, Frome Road, Adelaide, SA 5005, Australia; eugenie.lim{at}gmail.com

Abstract

Objective To determine whether short-term changes in liver tests (bilirubin, albumin, gamma glutamyl transferase, alkaline phosphatase, alanine aminotransferase (ALT) and aspartate aminotransferase) predict 12-month mortality and, if so, which test is most informative.

Design Retrospective review of general medicine inpatients at a tertiary hospital (2005–2012) identified non-elective admissions of minimum 7 days’ duration. Patients with liver disease, malignancy, admission to the intensive care unit or inpatient mortality were excluded. Linear spline modelled the vector of intra-admission change from admission. The association between 12-month mortality and admission and intra-admission changes in liver tests was assessed by logistic regression modelling, adjusted for age, gender, comorbidity index and heart failure.

Results 12-month mortality was 17% in 4160 patients analysed. 12-month mortality for patients with abnormally low albumin at admission was 5% higher per 1 g/L below 34 g/L (OR 0.95, 95% CI 0.93 to 0.98, p<0.001). Albumin and ALT were the only tests for which an intra-admission change significantly predicted mortality; the predictive effects were additive. 12-month mortality was greater by 4% per 1 g/L intra-admission decrement in albumin (OR 1.04, 95% CI 1.02 to 1.06, p<0.001) and 6% per 100 IU/L intra-admission increment in ALT (OR 1.06, 95% CI 1.02 to 1.1, p=0.005). Intra-admission changes were superior to admission values in predicting mortality.

Conclusions Changes in liver tests predict long-term mortality better than a single value and provide prognostic information more quickly than long-term monitoring. In the absence of known liver disease, albumin predicts long-term mortality better than transaminases. The patient whose albumin decreases in the short term is at high risk of death within 1 year, even from a normal baseline.

  • CHRONIC LIVER DISEASE
  • CARDIOVASCULAR DISEASE
  • ELDERLY

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