- Organ insufficiency: creatinine > 1.5 x upper normal serum level; bilirubin, aspartate amino transferase (AST), or alkaline phosphatase (AP) > 2.5 x upper normal serum level; heart failure (New York Heart Association (NYHA) III/IV); uncontrolled hypertension; unstable angina; serious cardiac arrhythmia; severe obstructive or restrictive ventilation disorder