Hernández-Zamonsett, Diego; Arellano-Juárez, Leonardo; Lezama-Urtecho, Carlos A; Jiménez-Olmedo, Daniel; Méndez-Ríos, Ubaldo; Martínez-Carmona, Rocío

ABSTRACT

Introduction: postoperative acute liver injury (ALI) is a frequent and severe complication of cardiac surgery with cardiopulmonary bypass (CPB), associated with high morbidity and mortality. However, the role of surgical complexity as an independent risk factor, beyond CPB duration, remains unclear. This study aimed to determine the incidence of ALI, identify its independent predictors, and quantify its impact on clinical outcomes. Material: a retrospective cohort study was conducted on 172 consecutive patients undergoing cardiac surgery with CPB. ALI was defined as a binary outcome based on peak postoperative laboratory values: (total bilirubin > 3 mg/dl) and (AST > 100 IU/l or ALT > 100 IU/l). A multivariate logistic regression model was used to identify ALI predictors (variables: baseline total bilirubin [TBL], CPB time, procedure group). The impact on outcomes (mortality, major bleeding, reoperation) was assessed using χ2 tests and crude odds ratios (ORs). Results: the overall incidence of ALI was 32 (18.6%) out of 172 patients. In the multivariate analysis, Complex procedure was the only independent and statistically significant predictor (adjusted OR 10.06, 95%CI 2.36-42.88; p = 0.002), rendering CPB time no longer an independent predictor (p = 0.511) and baseline TBL (p = 0.548). Patients who developed ALI exhibited complication rates two to three times higher. A strong trend of association with major bleeding was observed (crude OR 3.05; p = 0.089). Associations with mortality (OR 2.52; p = 0.169) and reoperation (OR 2.76; p = 0.125) did not reach statistical significance. Conclusions: surgical complexity (complex procedure) is the primary determinant for postoperative ALI, independent of CPB duration. ALI is a sentinel event for severe morbidity, strongly associated with the risk of major bleeding. The magnitude of the observed effect on mortality (OR > 2.5) generates a robust hypothesis that warrants prospective studies with greater statistical power for validation.

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