Elevated alanine transaminase is nonlinearly associated with in-hospital death in ICU-admitted diabetic ketoacidosis patients

Abstract

Aims: To investigate the association between alanine transaminase (ALT) and in-hospital death in patients admitted to the intensive care unit for diabetic ketoacidosis (DKA).

Methods: A cohort of 2,684 patients was constructed from the eICU Collaborative Research Database. Baseline demographic and clinical characteristics were summarized. Cox regressions with restricted cubic spline functions were modelled to explore the association between alanine transaminase and in-hospital death. Subgroup analyses were conducted between sexes, age groups, and people with/without obesity.

Results: After adjusting multiple confounders, a nonlinear, S-shaped association between ALT and in-hospital death was found. Compared to patients at median ALT, patients at the 90th percentile of ALT have a 1.88 (95 % confidence interval [CI]: 1.34-2.62) times higher hazard of in-hospital death in the unstratified cohort. Similar results were found in males (hazard ratio [HR] = 1.69, 95 % CI: 1.24-2.30); patients aged under 65 years (HR = 1.65, 95 % CI: 1.09-2.49); patients aged 65 years or above (HR = 3.45, 95 % CI: 1.67-7.14); non-obese patients (HR = 1.52, 95 % CI: 1.00-2.32); and obese patients (HR = 2.76, 95 % CI: 1.38-5.54).

Conclusions: Elevated ALT is robustly associated with in-hospital death in ICU-admitted DKA patients across several subgroups. Close monitoring of ALT in these patients is recommended.

Keywords: Alanine transaminase; Diabetic ketoacidosis; In-hospital death; Intensive care unit.