Cardiothoracic & vascular anaesthesia
The association between cardiac surgery – associated acute kidney injury and elevated liver function tests. A single-center cohort study
Authors' conclusion
AST activity may have potential as a predictor of CSA-AKI and use of RRT, although liver enzymes demonstrated a weak association with CSA-AKI.
Study context
- Population
- Adult cardiac surgery patients during a 6-year period
- Participants
- 3,415 patients
- Exposure
- AST/upper limits of normal (ULN) and ALT/ULN at ICU admission as predictors of CSA-AKI
- Outcome
- Prediction of CSA-AKI by liver enzymes normalized to ULN
- Follow-up
- ICU admission
Main finding
As reported in the abstract
- AST/ULN AUC-ROC (95% CI)
- 0.587 (0.570-0.604); p < 0.001
- ALT/ULN AUC-ROC (95% CI)
- 0.534 (0.517-0.551); p < 0.001
- AST performing better than ALT
- p < 0.001
Observational data: associations, not effects.
Secondary outcomes
Incidence of CSA-AKI, AKI stage ≥2 and renal replacement therapy (RRT)
- Developed CSA-AKI
- 65.4%
- AKI stage ≥2
- 37.4%
- Received RRT
- 3.8%
Prediction of AKI ≥2 · ICU admission
- AST/ULN AUC-ROC (95% CI)
- 0.594 (0.577-0.610); p < 0.001
- ALT/ULN AUC-ROC (95% CI)
- 0.541 (0.524-0.585); p < 0.001
Prediction of RRT · 12 h after ICU admission
- AST/ULN AUC-ROC (95% CI), strongest predictor
- 0.751 (0.733-0.768); p < 0.001
- RRT risk when AST exceeded 1.6 times the ULN
- 4-fold increased
Association of AST and ALT with central venous pressure (CVP) · 24 h post ICU admission
- AST
- R2 = 0.007; p = 0.003
- ALT
- R2 = 0.006; p = 0.004
- Weakly associated
Original publication
The association between cardiac surgery – associated acute kidney injury and elevated liver function tests. A single-center cohort study. J Crit Care. Published 7 October 2026. doi:10.
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