De Ritis-adjusted AST provides comparable efficacy to lactate dehydrogenase as a biomarker for detection of LVAD hemolysis or thrombosis.
De Ritis-adjusted AST
aspartate aminotransferase
biomarker
hemolysis
lactate dehydrogenase
left ventricular assist device
thrombosis
Journal
Artificial organs
ISSN: 1525-1594
Titre abrégé: Artif Organs
Pays: United States
ID NLM: 7802778
Informations de publication
Date de publication:
Jul 2022
Jul 2022
Historique:
revised:
05
02
2022
received:
26
10
2021
accepted:
02
03
2022
pubmed:
24
3
2022
medline:
11
6
2022
entrez:
23
3
2022
Statut:
ppublish
Résumé
Lactate hydrogenase (LDH) is a common biomarker utilized in the detection and monitoring of left ventricular assist device (LVAD) hemolysis and thrombosis. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are common laboratory tests that can be used to calculate the De Ritis ratio and the De Ritis adjusted AST. A retrospective review of LVAD patients was performed to identify three cohorts of patients: those with confirmed pump thrombosis after device exchange, those with LVAD-related hemolysis who were medically managed without pump exchange, and those who did not meet these criteria and served as the control cohort. Evaluation of AST, AST/ALT ratio (referred to as the De Ritis ratio) as well as AST x (AST/ALT) or the De Ritis-adjusted AST (DRA) was performed. There were 29 patients who underwent device exchange for thrombosis, 25 patients who were diagnosed with hemolysis and treated medically (clopidogrel (N = 6), heparin (N = 13), tirofiban (N = 8), eptifibatide (N = 2), and some received more than one of these treatments), and 425 control patients. A qualitatively comparable relative and absolute rise in DRA and LDH were found in both surgically managed pump thrombosis and suspected device-related hemolysis. Both AST and LDH as well DRA are significantly associated with pump thrombosis (p < 0.0001 for each). DRA is a potential screening biomarker for hemolysis and device thrombosis in stable left ventricular assist device patients.
Sections du résumé
BACKGROUND
BACKGROUND
Lactate hydrogenase (LDH) is a common biomarker utilized in the detection and monitoring of left ventricular assist device (LVAD) hemolysis and thrombosis. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are common laboratory tests that can be used to calculate the De Ritis ratio and the De Ritis adjusted AST.
METHODS
METHODS
A retrospective review of LVAD patients was performed to identify three cohorts of patients: those with confirmed pump thrombosis after device exchange, those with LVAD-related hemolysis who were medically managed without pump exchange, and those who did not meet these criteria and served as the control cohort. Evaluation of AST, AST/ALT ratio (referred to as the De Ritis ratio) as well as AST x (AST/ALT) or the De Ritis-adjusted AST (DRA) was performed.
RESULTS
RESULTS
There were 29 patients who underwent device exchange for thrombosis, 25 patients who were diagnosed with hemolysis and treated medically (clopidogrel (N = 6), heparin (N = 13), tirofiban (N = 8), eptifibatide (N = 2), and some received more than one of these treatments), and 425 control patients. A qualitatively comparable relative and absolute rise in DRA and LDH were found in both surgically managed pump thrombosis and suspected device-related hemolysis.
CONCLUSIONS
CONCLUSIONS
Both AST and LDH as well DRA are significantly associated with pump thrombosis (p < 0.0001 for each). DRA is a potential screening biomarker for hemolysis and device thrombosis in stable left ventricular assist device patients.
Substances chimiques
Biomarkers
0
L-Lactate Dehydrogenase
EC 1.1.1.27
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1425-1428Informations de copyright
© 2022 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.
Références
Levin AP, Saeed O, Willey JZ, Levin CJ, Fried JA, Patel SR, et al. Watchful waiting in continuous-flow left ventricular assist device patients with ongoing hemolysis is associated with an increased risk for cerebrovascular accident or death. Circ Heart Fail. 2016;9:e002896.
Shah P, Mehta VM, Cowger JA, Aaronson KD, Pagani FD. Diagnosis of hemolysis and device thrombosis with lactate dehydrogenase during left ventricular assist device support. J Heart Lung Transplant. 2014;33:102-4.
Uriel N, Han J, Morrison KA, Nahumi N, Yuzefpolskaya M, Garan AR, et al. Device thrombosis in HeartMate II continuous-flow left ventricular assist devices: a multifactorial phenomenon. J Heart Lung Transplant. 2014;33:51-9.
Washington IM, Van Hoosier G. Clinical biochemistry and hematology, Chapter 3. London, UK: Academic Press; 2012. p. 57-116.
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