Acute Hepatic Injury Following Cardiac Surgery: Retrospective Observational Study

Abstract

Objective: Cardiopulmonary bypass (CPB) and cardiac surgery can have multiple systemic effects on the patient. This retrospective study aims to investigate the effect of this change on liver enzymes. Methods: Demographic data, comorbidities, preoperative and postoperative laboratory data, intraoperative cross-clamp and CPB duration, blood and blood product transfusions, and fluid balance of 390 patients who underwent on-pump coronary artery bypass grafting (CABG) were retrospectively reviewed. Patients with a twofold or greater increase in postoperative alanine transaminase were considered to have an acute hepatic injury (Group AHI). Multivariate logistic regression was performed to find independent predictors for AHI. Results: Body mass index, hyperlipidemia, and diabetic patients were significantly higher in group AHI (p<0.05). Similarly, fresh frozen plasma (FFP) transfusion, platelet transfusion, and the need for insulin, dopamine, and adrenaline were observed to be higher in the AHI group in the intraoperative period (p<0.05).Cardiopulmonary bypass time was longer and total urine volume was less in Group AHI (p<0.05). The need for intraaortic balloon pump (IABP) and/or extracorporeal membrane oxygenation (ECMO) on weaning from the CPB pump was seen in more patients in Group AHI (p=0.021). According to the results of multivariate logistic regression analysis, it was determined that the risk of AHI is 2.27 (1.144-4.543, 95% CI, p=0.019) times higher in hyperlipidemic patients, 2.84 (1.077-7.494, 95% CI, p=0.35) times higher in patients who need intraoperative 3-4 units of FFP, and 4.37 (1.107-17.264, 95% CI, p=0.035) times higher in patients who need IABP and/or ECMO after CPB. Conclusion: There is a strong relationship between AHI after cardiac surgery and hyperplidemia, FFP transfusion, and the need for IABP and/or ECMO.