Correlation of Serum Cardiac Markers with Acute Decompensating Events in Liver Cirrhosis

Abstract

Background and Aim. Liver cirrhosis is often accompanied by insidious cardiac dysfunction. This retrospective cross-sectional study is aimed at exploring the correlation between serum cardiac markers and decompensating events in liver cirrhosis. Methods. Cirrhotic patients who were consecutively hospitalized between January 2016 and March 2019 were screened. Serum cardiac biomarkers at admission, including N-Terminal pro-B-type natriuretic peptide (NT-pro BNP), high-sensitivity cardiac troponin T (hs-cTnT), creatine kinase (CK), creatine kinase MB (CK-MB), and lactate dehydrogenase (LDH), were collected. Acute decompensating events at admission, primarily including ascites, acute gastrointestinal hemorrhage, and acute-on-chronic liver failure (ACLF), were recorded. Results. The NT-pro BNP level was significantly higher in cirrhotic patients with acute decompensating events than in those without any decompensating events (median: 140.75 pg/mL versus 41.86 pg/mL, P<0.001). The NT-pro BNP level significantly correlated with ascites, acute gastrointestinal hemorrhage, and ACLF. The hs-cTnT level was significantly higher in cirrhotic patients with acute decompensating events than in those without decompensating events (median: 0.008 ng/mL versus 0.006 ng/mL, P=0.007). The hs-cTnT level significantly correlated with acute gastrointestinal hemorrhage, but not ascites or ACLF. LDH (185.0 U/L versus 173.5 U/L, P=0.281), CK (71 U/L versus 84 U/L, P=0.157), and CK-MB (29.5 U/L versus 33.0 U/L, P=0.604) levels were not significantly different between cirrhotic patients with and without acute decompensating events. Conclusion. The elevated NT-pro BNP level seems to be closely related to the development of acute decompensating events in liver cirrhosis.

Markers of cardiac injury in patients with liver cirrhosis

“…cTnT concentration also correlated with portal vein diameter, the length of the corrected QT interval in the ECG, left ventricular mass, interventricular septal diameter, peak velocity of atrial filling, and carotid intima-media thickness (42). cTnT concentrations were significantly higher in hospitalized patients with decompensated liver cirrhosis compared with those with compensated liver cirrhosis (45). However, cTnt significantly correlated with gastrointestinal bleeding but not with other forms of cirrhosis decompensation during hospital stay (45).…”

“…cTnT concentrations were significantly higher in hospitalized patients with decompensated liver cirrhosis compared with those with compensated liver cirrhosis (45). However, cTnt significantly correlated with gastrointestinal bleeding but not with other forms of cirrhosis decompensation during hospital stay (45). It has to be noted that most participants of the mentioned studies had alcoholic or post-HCV liver cirrhosis, while patients with other causes of cirrhosis were less represented (45).…”

“…However, cTnt significantly correlated with gastrointestinal bleeding but not with other forms of cirrhosis decompensation during hospital stay (45). It has to be noted that most participants of the mentioned studies had alcoholic or post-HCV liver cirrhosis, while patients with other causes of cirrhosis were less represented (45). The relationships between cardiac troponins and mortality, Child-Pugh and MELD scores, and left ventricular function are shown in Table 1.…”

“…cTnT was found to be higher in patients with liver cirrhosis and was a significant predictor of the severity of liver cirrhosis as assessed by the Child-Pugh and MELD score (40)(41)(42)(43). Also, its concentration correlated with overall mortality in patients with liver cirrhosis regardless of the presence of cardiac disease (41)(42)(43)(44)(45)(46). cTnT concentration also correlated with portal vein diameter, the length of the corrected QT interval in the ECG, left ventricular mass, interventricular septal diameter, peak velocity of atrial filling, and carotid intima-media thickness (42).…”

Adherence to Non-Selective Beta Blockers for Prevention of Variceal Bleeding in Cirrhotic Patients

“…A total of 113 patients treated by one attending physician (XQ) from February 2018 to June 2019 were prospectively recorded and retrospectively screened and analyzed, as previously mentioned. 24,25 The inclusion criteria were as follows: (1) a diagnosis of liver cirrhosis; and (2) an indication of NSBBs for primary or secondary prophylaxis of variceal bleeding during hospitalizations. Age, sex, etiology of liver cirrhosis, and hepatocellular carcinoma were not limited.…”