Analysis of clinical features and risk factors of cardiac insufficiency complicated with ischemic hepatitis

doi:10.3877/cma.j.issn.2095-2015.2022.02.004

Abstract

Abstract:

Objective

To analyze the biochemical characteristics and predisposing factors of ischemic hepatitis (IH) in patients with cardiac insufficiency, and to provide theoretical support for the prevention of IH.

Methods

A total of 364 patients with cardiac insufficiency admitted from January l, 2010 to November 30, 2018 in Liaocheng People's Hospital were retrospectively analyzed. There were 20 patients with IH (IH group), and 30 patients without IH were selected as the control group by stratified random sampling to analyze the clinical characteristics and predisposing factors of IH.

Results

The mean age of patients in IH group was (73.5±2.4) years, which was older than that in the control group (65.5±2.9) years (P<0.05). The proportions of inducing factors such as upper respiratory tract infection, acute attack of chronic bronchitis and arrhythmia in the IH group were higher than those in the control group, with statistically significant differences (P<0.05). The mortality in the IH group was 35.0% (7/20), which was significantly higher than 13.3% (4/30) in the control group (P<0.05). The main causes of death were upper respiratory tract infection, acute attack of chronic bronchitis, arrhythmia and other inducing factors poorly controlled, and aggravation of cardiac insufficiency. The levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and lactic dehydrogenase (LDH) increased rapidly, which was more than 20 times higher than the upper limit of normal value. The elevation of AST was higher than that of ALT, and recovered rapidly about 10 days later. The changes of total bilirubin, alkaline phosphates and γ-glutamyl transferase were not obvious. Age stratification showed that the incidence of IH in ≥70 years old patients was higher than that in <70 years old patients, and AST level took longer to return to normal, and there were statistically significant differences (P<0.05), suggesting that advanced age was a risk factor for IH. According to the classification and stratification of heart function of New York Heart Association (NYHA), the incidence of IH in NYHA Ⅲ+Ⅳ patients was higher than that in NYHA Ⅰ+Ⅱ patients, and AST level took longer to return to normal, and there were statistically significant differences (P<0.05). The incidence of IH in patients with global cardiac insufficiency was higher than that in patients with left heart failure, and it took longer time for AST level to return to normal, and there were statistically significant differences (P<0.05), suggesting that poor cardiac function was a risk factor for IH. Multiple regression analysis showed that NYHA cardiac function grade and predisposing factors were the risk factors for IH.

Conclusions

Predisposing factors and poor cardiac reserve function are risk factors of IH in patients with cardiac insufficiency. Timely application of antibiotics to prevent infection and correct arrhythmia are very important to improve the prognosis of patients with cardiac insufficiency complicated with IH.

Key words: Ischemic hepatitis, Cardiac insufficiency, Diagnosis, Dangerous factors

Qi Zhao, Weijia Li, Cong Li, Zhenfang Li, Changqing Xu. Analysis of clinical features and risk factors of cardiac insufficiency complicated with ischemic hepatitis[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2022, 12(02): 82-87.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhxhbyyxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-2015.2022.02.004

https://zhxhbyyxzz.cma-cmc.com.cn/EN/Y2022/V12/I02/82

Figures/Tables 5

References 20

1	张昕,吕丹,刘丹阳.肝硬化食管胃底静脉曲张破裂出血伴缺血性肝炎的危险因素分析[J].肝脏, 2022, 27(1): 47-50．
2	Ucgun I, Ozakyol A, Metintas M, et al. Relationship between hypoxic hepatitis and cot pulmonale in patients treated in the respiratory ICU [J]. Int J Clin Pract, 2005, 59(11): 1295-1300.
3	安田,宏他.休克肝[J].日本会志, 1989, 78(5): 629.
4	Gibson PR, Dudley FJ. Ischemic hepatitis: clinical features, diagnosis and prognosis [J]. Aust N Z J Med, 1984, 14(6): 822-825.
5	Fuchs S, Bogomolski-Yahalom V, Paltiel O, et al. Ischemic hepatitis: clinical and laboratory observations of 34 patients [J]. J Clin Gastroenterol, 1998, 26(3): 183-186.
6	沈本强,董立谦,麻勇.缺血性肝炎的研究进展[J].中华肝脏病杂志, 2018, 26(9): 707-709.
7	复旦大学上海医学院,《实用内科学》编委会,陈灏珠.心脏功能不全[M]//实用内科学. 12版.北京:人民卫生出版社, 2005: 1339.
8	Henrion J, Schapira M, Luwaert R, et al. Hypoxic Hepatitis: Clinical and Hemodynamic Study in 142 Consecutive Cases [J]. Medicine (Baltimore), 2003, 82(6): 392-406.
9	Henrion J, Colin L, Schmitz A, et al. Ischemic hepatitis in cirrhosis: rare but lethal [J]. J Clin Gastroenterol, 1993, 16(1): 35-39.
10	胡群英.肝硬化上消化道出血并发缺血性肝炎的临床特征与预后分析[J].中国医师进修杂志, 2010, 33(24): 39-41.
11	Gitlin N, Serio KM. Ischemic hepatitis: widening horizons [J]. Am J Gastroenterol, 1992, 87(7): 831-836.
12	Panwar V, Ranaweera P. Ischemic hepatitis secondary to hepatic artery steal in a patient with celiac artery aenosis and severe postural hypotension [J]. Catheter Cardiovasc Interv, 2011, 78(5): 799-801.
13	Henrion J, De Maeght S, Schapira M, et al. Hypoxic hepatitis: a difficult diagnosis when the cardiomyopathy remains unrecognized and the course of liver enzyme follows an atypical pattern. A report of two cases [J]. Acta Gastroenterol Belg, 1998, 61(3): 385-389.
14	Seeto RK, Fenn B, Rockey DC. Ischemic hepatitis: clinical presentation and pathogenesis [J]. Am J Med, 2000, 109(2): 109-111.
15	Birrer R, Takuda Y, Takara T. Hypoxic hepatopathy pathophsiology and prognosis [J]. Intern Med, 2007, 46(14): 1063-1070.
16	王艳英,齐艳英,韩志艳.缺血性肝炎的影响因素及临床特征[J].中华老年医学杂志, 2013, 32(11): 1189-1191.
17	Kleber FX, Petersen S. The peripheral syndrome of heart failure: the overlooked aspects [J]. Eur Heart J, 1998, 19(Suppl): L10-L14.
18	Lowe MD, Harcombe AA, Grace AA, et al. Restrictive-constrictive heart failure masquerading as liver disease [J]. Br Med J, 1999, 318(7183): 585-586.
19	吕利雄,朱顺和.高龄患者心功能不全所致缺血性肝炎35例临床研究[J].临床荟萃, 2001, 16(6): 260-261.
20	Giannini EG, Testa R, Savarino V. Liver enzyme alteration: a guide for inicians [J]. CMAJ, 2005, l72(3): 367-379.

组别	例数	年龄（±s，岁）	性别（男性/女性，例）	NYHA心功能分级（例）				诱发因素（例）		死亡（例）
组别	例数	年龄（±s，岁）	性别（男性/女性，例）	Ⅰ级	Ⅱ级	Ⅲ级	Ⅳ级	有	无	死亡（例）
IH组	20	73.5±2.4	11/9	0	2	12	6	17	3	7
对照组	30	65.5±2.9	22/8	2	5	15	8	3	27	4
P值		0.013	0.21	0.451				0.026		0.016

组别	例数	年龄（±s，岁）	性别（男性/女性，例）	NYHA心功能分级（例）				诱发因素（例）		死亡（例）
组别	例数	年龄（±s，岁）	性别（男性/女性，例）	Ⅰ级	Ⅱ级	Ⅲ级	Ⅳ级	有	无	死亡（例）
IH组	20	73.5±2.4	11/9	0	2	12	6	17	3	7
对照组	30	65.5±2.9	22/8	2	5	15	8	3	27	4
P值		0.013	0.21	0.451				0.026		0.016

组别	例数	AST（U/L）	ALT（U/L）	TBil（μmol/L）	DBil（μmol/L）	γ-GT（U/L）	ALP（U/L）	LDH（U/L）
IH组	20	2712±1024	2177±987	88.7±42.7	35.9±15.3	50.2±20.7	79.3±21.9	241.0±26.0
对照组	30	75±24	56±7	43.0±7.2	29.7±23.8	65.6±14.5	81.7±12.1	60.5±10.7
t值		4.03	5.62	1.42	1.54	1.52	1.53	4.67
P值		<0. 05	<0. 05	>0.05	>0.05	>0.05	>0.05	<0.05

组别	例数	AST（U/L）	ALT（U/L）	TBil（μmol/L）	DBil（μmol/L）	γ-GT（U/L）	ALP（U/L）	LDH（U/L）
IH组	20	2712±1024	2177±987	88.7±42.7	35.9±15.3	50.2±20.7	79.3±21.9	241.0±26.0
对照组	30	75±24	56±7	43.0±7.2	29.7±23.8	65.6±14.5	81.7±12.1	60.5±10.7
t值		4.03	5.62	1.42	1.54	1.52	1.53	4.67
P值		<0. 05	<0. 05	>0.05	>0.05	>0.05	>0.05	<0.05

时间	ALT（U/L）	AST（U/L）	LDH（U/L）	TBil（μmol/L）	DBil（μmol/L）	PT（s）
入院时	2112±781	2643±837	231±27	78±18	34±9	13±2
入院第5天	543±169	578±201	183±14	66±14	33±6	14±3
入院第8天	112±46.3	179±47.4	143±14	46±14	32±7	13±2
F值	9.32	9.21	2.69	1.18	1.41	1.19
P值	<0.01	<0.01	<0.05	>0.05	>0.05	>0.05

Please choose a citation manager

Content to export