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Creatine kinase (CK), creatine kinase-MB isoenzyme (CKMB) and cardiac troponin-I (cTnI) were analyzed as markers of myocardial injury. For histological analysis,<jats:italic>hematoxylin-eosin<\/jats:italic>(HE),<jats:italic>elastic Van Gieson<\/jats:italic>(EVG), CD41 and myeloperoxidase were used to stain rat hearts. Major adverse cardiac events (MACEs) were a critical factor for mortality (p = 0.037) in human ALF. Deceased patients exhibited higher levels of CKMB than survivors (p = 0.023). CKMB was a predictor of mortality in ALF (p = 0.013). Animals that died early after BDL exhibited increased cTnI, CKMB, tumor necrosis factor \u03b1 (TNF\u03b1) and interleukin-6 (IL-6) levels compared to controls (cTnI: p = 0.011, CKMB: p = 0.008, TNF\u03b1: p = 0.003, IL-6: p = 0.006). These animals showed perivascular lesions and wavy fibers, microthrombi and neutrophilic infiltration in the heart. MACEs are decisive for mortality in human ALF, and elevated CKMB values indicate that this might be due to structural myocardial damage. Accordingly, CKMB was found to have predictive value for mortality in ALF. The results are substantiated by data from a rat BDL model demonstrating diffuse myocardial injury.<\/jats:p>","DOI":"10.1371\/journal.pone.0256790","type":"journal-article","created":{"date-parts":[[2021,8,30]],"date-time":"2021-08-30T17:36:37Z","timestamp":1630344997000},"page":"e0256790","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Acute myocardial injury secondary to severe acute liver failure: A retrospective analysis supported by animal data"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6533-6515","authenticated-orcid":true,"given":"Moritz","family":"Uhlig","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc","family":"Hein","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Moriz A.","family":"Habigt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ren\u00e9 H.","family":"Tolba","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Till","family":"Braunschweig","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marius J.","family":"Helmedag","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Uwe","family":"Klinge","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Koch","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Trautwein","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mare","family":"Mechelinck","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,8,30]]},"reference":[{"issue":"11","key":"pone.0256790.ref001","doi-asserted-by":"crossref","first-page":"2459","DOI":"10.1111\/j.1572-0241.2007.01388.x","article-title":"Population-based surveillance for acute liver failure","volume":"102","author":"WA Bower","year":"2007","journal-title":"Am J Gastroenterol"},{"issue":"2","key":"pone.0256790.ref002","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/j.cld.2018.01.001","article-title":"Classification and Epidemiologic Aspects of Acute Liver Failure","volume":"22","author":"D Pievsky","year":"2018","journal-title":"Clin Liver Dis"},{"issue":"2","key":"pone.0256790.ref003","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1016\/j.cld.2018.01.013","article-title":"Management of Acute Liver Failure in the Intensive Care Unit Setting","volume":"22","author":"P Rajaram","year":"2018","journal-title":"Clin Liver Dis"},{"issue":"2","key":"pone.0256790.ref004","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/j.gtc.2018.01.005","article-title":"Modern Management of Acute Liver Failure","volume":"47","author":"R Khan","year":"2018","journal-title":"Gastroenterol Clin North Am"},{"issue":"1","key":"pone.0256790.ref005","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1055\/s-0032-1301733","article-title":"Acute liver failure","volume":"33","author":"WM Lee","year":"2012","journal-title":"Semin Respir Crit Care Med"},{"key":"pone.0256790.ref006","unstructured":"ALFSG. 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