Apart from hypoxic hepatitis (HH), the hepatic consequences of out-of-hospital cardiac arrest (OHCA) have been little studied. This cohort study aimed to investigate the characteristics of liver dysfunction resulting from OHCA and its association with outcomes. Among the conventional static liver function tests used to define acute liver failure (ALF), we determined which one correlated more closely with the reference indocyanine green (ICG) clearance test in a series of OHCA patients from the CYRUS trial (NCT01595958). Subsequently, we assessed whether ALF, in addition to HH (i.e., acute liver injury), was an independent risk factor for death in a large cohort of OHCA patients admitted to two intensive care units between 2007 and 2017. ICG clearance, available for 22 patients, was impaired in 17 (77.3%) cases. Prothrombin time (PT) ratio was the only static liver function test that correlated significantly (r = -0.66, < 0.01) with ICG clearance and was therefore used to define ALF, with the usual cutoff of < 50%. Of the 418 patients included in the analysis (sex ratio: 1.4; median age: 64 [53–75] years; non–shockable rhythm: 73%), 67 (16.0%) presented with ALF, and 61 (14.6%) had HH at admission. On day 28, 337 (80.6%) patients died. Following multivariate analysis, ALF at admission, OHCA occurring at home, absence of bystander, non–cardiac cause of OHCA, low-flow duration ≥ 20 min, and SOFA score excluding liver subscore at admission were independently associated with day 28 mortality. ALF occurred frequently after OHCA and, unlike HH, was independently associated with day 28 mortality.

中文翻译：

---

院外心脏骤停后急性肝功能衰竭：一项观察性研究

除了缺氧性肝炎（HH）外，院外心脏骤停（OHCA）对肝脏的影响还很少被研究。本队列研究旨在调查 OHCA 引起的肝功能障碍的特征及其与结果的关系。在用于定义急性肝衰竭 (ALF) 的传统静态肝功能测试中，我们在 CYRUS 试验 (NCT01595958) 的一系列 OHCA 患者中确定了哪一项与参考吲哚菁绿 (ICG) 清除率测试更密切相关。随后，我们评估了 2007 年至 2017 年间入住两个重症监护病房的一大群 OHCA 患者中，除 HH（即急性肝损伤）外，ALF 是否是死亡的独立危险因素。ICG 清除，适用于 22 17 例（77.3%）患者受到损害。凝血酶原时间 (PT) 比率是唯一与 ICG 清除率显着相关（r = -0.66，< 0.01）的静态肝功能测试，因此用于定义 ALF，通常的截止值 < 50%。在纳入分析的 418 名患者中（性别比：1.4；中位年龄：64 [53-75] 岁；不可电击心律：73%），67 名（16.0%）患有 ALF，61 名（14.6%）患有 ALF入院时HH。第 28 天，337 名患者（80.6%）死亡。多变量分析显示，入院时 ALF、在家中发生 OHCA、没有旁观者、非心脏原因导致 OHCA、低流量持续时间≥ 20 分钟以及入院时排除肝脏分项的 SOFA 评分与第 28 天死亡率独立相关。 ALF 在 OHCA 后频繁发生，与 HH 不同，ALF 与第 28 天死亡率独立相关。