Liver dysfunction in patients with acute pulmonary embolism

Aim: Although liver injury due to cardiac, chronic respiratory and circulatory failure has been reported, this has yet to be studied in patients with pulmonary embolism (PE). We investigated liver injury in patients with acute PE. Methods: We retrospectively reviewed 107 acute PE patients over a two‐year period. Patients were categorized as having: (1) severe (P_aO₂ < 45 mmHg), moderate (45 mmHg ≤ P_aO₂≤ 60 mmHg) or mild hypoxemia (60 mmHg < P_aO₂ < 80 mmHg) groups; (2) massive and non‐massive PE; (3) absence or presence of pre‐existing cardiopulmonary disease; and (4) absence or presence of right ventricle dysfunction. Serum levels of liver enzymes were compared between groups. Results: Transaminase levels were higher in severe hypoxemia patients compared mild hypoxemia patients (p=0.045 and p=0.036). Albumin and bilirubin levels were lower and higher, respectively, in patients with severe and moderate hypoxemia compared to mild hypoxemia patients (p < 0.05 and p < 0.01). There was a negative correlation between hepatic markers and P_aO₂ and %S_aO₂: r=–0.212, p=0.032 between AST and %S_aO₂; r=–0.243, p=0.013 and r=–0.241, p=0.014 between ALT and P_aO₂ and %S_aO₂; and r=–0.224, p=0.024 and r= –0.283, p=0.004 between direct bilirubin and P_aO₂ and %S_aO₂. AST and ALT levels were higher in massive PE than non‐massive PE patients (p=0.0001). Albumin levels were lower in patients with right ventricle dysfunction than in those without (p=0.02). One (0.9%) had a clinical picture of hypoxic hepatitis. Conclusion: Abnormal LFTs showed a mixed pattern in patients with acute PE.