Arch Crit Care Med. 2016 February; 2(1):e55433. Published online 2016 January 31. doi: 10.17795/accm-55433. Research Article The Relationship Between Changes in Liver Enzymes and Mortality of Patients Admitted to a Surgical Intensive Care Unit Omid Moradi Moghaddam, 1 Mahzad Alimian, 2,* Mohammad Niakan Lahiji, 1 Valiollah Hasani, 3 and Ali Ahani Azari 4 1 Assistant Professor of Anesthesiology and Critical Care department, Rasool-e-Akram Complex Hospital, Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran, IR Iran 2 Assistant Professor of Anesthesiology and Pain Department, Rasool-e-Akram Complex Hospital, Iran University of Medical Sciences, Tehran, IR Iran 3 Professor of Anesthesiology and Pain Department, Rasool-e-Akram Complex Hospital, Iran University of Medical Sciences, Tehran, IR Iran 4 Resident of Anesthesiology and Pain Department, Rasool-e-Akram Complex Hospital, Iran University of Medical Sciences, Tehran, IR Iran * Corresponding author: Mahzad Alimian, Assistant Professor of Anesthesiology and Pain Department, Rasool-e-Akram Complex Hospital, Iran University of Medical Sciences, Tehran, IR Iran. Tel: +98-9113712085, E-mail: mahzadalimian@gmail.com Received 2015 December 06; Accepted 2016 January 05. Abstract Background: Increased levels of alanine transaminase (ALT) and alkaline phosphatase in the liver are associated with an increased risk of mortality in hospitalized patients. This study aimed to survey the relationship between changes in liver enzymes and mor- tality of patients admitted to a surgical intensive care unit (ICU). Methods: This cross sectional study was based on the electronic and clinical records of patients, hospitalized in the ICU of Rasool Akram hospital from 2012 to 2015. The information of 199 alive and 140 deceased patients was studied. The laboratory parameters, clinical information, acute physiology and chronic health evaluation (APACHE-II) scores, and sequential organ failure assessment (SOFA) scores were determined upon admission, and length of ICU stay was measured. Results: There was a significant difference in the aspartate aminotransferase (AST) level upon admission in alive and deceased groups (42.01 ± 46.65 and 58.54 ± 80.95 mg/dL, respectively) (P < 0.05). However, there was no significant difference in the level of AST at discharge between the groups (39.05 ± 36.69 and 67.95 ± 21.7mg/dL, respectively) (P > 0.05). There was a significant difference in the level of ALT upon admission between the groups (34.21 ± 58.13 and 41.32 ± 66.77 mg/dL, respectively) (P > 0.05). However, there was no significant difference in ALT level at discharge between the groups (38.44 ± 48.69 and 42.94 ± 76.47 mg/dL, respectively) (P > 0.05). Based on the multivariate logistic regression model, the predictive factors for mortality included use of inotropes, alkaline phosphatase, and reduced platelet count, potassium level, and heart rate. Conclusions: Measurement of serum liver enzymes has inadequate predictive value for mortality in ICU patients. Keywords: Liver Enzyme, Mortality, Intensive Care Units 1. Background Liver plays a key role in the synthesis and metabolism of proteins, toxins, and drugs and is involved in the regu- lation of immune system (1). Acute liver failure or sudden liver damage is associated with acute liver function failure and can result in brain malfunctions, such as encephalopa- thy (2). In liver damage, hepatocellular permeability in- creases, and aspartate aminotransferase (AST) and alanine aminotransferase (ALT) secrete from the internal part of the cell to the plasma. The time it takes for liver enzymes to increase in level depends on the intensity of enzyme production in the liver, as well as enzyme half-life, ranging from 17 hours for AST to 50 hours for ALT (3). In case of liver cell malfunction, variations are predictable in the plasma level of several markers. Bilirubin is associated with liver function and is largely used in scoring systems of organic functional dis- orders, such as sequential organ failure assessment (SOFA) in intensive care units (ICUs). However, this index is a de- layed marker of liver function disorder, and serum biliru- bin level may remain low in the primary stages of disorder (4-8). However, serum albumin level cannot be a specific test for liver function in some patients (9, 10). Similarly, the international normalized ratio (INR) is not a specific test for liver function disorder in ICU patients (11, 12). Several factors have been mentioned for liver function disorder in patients hospitalized in ICUs, including hypoxic hepatitis, Copyright © 2016, Archives of Critical Care Medicine. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.