Prognostic Significance of Increased Serum Bilirubin Levels Coincident With Cardiac Decompensation in Chronic Heart Failure

Aim: To evaluate the relationship of abnormal Liver Function Tests (LFTs) to outcomes in patients with heart failure due to reduced ejection fraction (HFREF) at the time of diagnosis in the heart failure clinic. Methods:We undertook a retrospective analysis of all patients diagnosed with HFREF in the heart failure outpatient clinic of a tertiary teaching hospital from 2007 to 2011. Ninety-five patients with abnormal LFTs at presentation were compared with 127 contemporaneous randomly chosen patients with normal LFTs and their outcomes were analyzed. Time to event data mortality and admission rates, as well as length of hospital stay during admissions were assessed. Results:Of 222 patients 69% were Male. The mean age across both the groups was 69.2 ± 13.2 years. The major ethnic group was of white background (78%). Majority of patients were in NYHA class 2 (54.5%). On multivariate analysis, low albumin at the time of diagnosis was the strongest predictor of all cause death (OR 1.24, 95% CI 1.15-1.35, p<0.0001). Patients in the abnormal LFT group had a longer in-hospital stay compared to those in the normal LFT group (25.9 ± 29.1 days vs. 17.2 ± 20.5 days, p=0.01). Low albumin and elevated alkaline phosphatase (ALP) were the strongest predictors of increased length of in-hospital stay following heart failure related admissions on multivariate analysis (OR -0.583, CI -1.119, -0.046, p=0.035 and OR 0.033, CI 0.005, 0.061, p=0.02, respectively). Every unit increase of albumin resulted in reduction of in hospital stay by 0.875 days. Time to event analysis showed more deaths in the abnormal LFT group when compared to the normal LFT group (log rank test p=0.012). Although an elevated ALP was seen to be associated with readmission, multivariate analysis found this to be a trend only, with none of the LFTs being predictive. Conclusion:Abnormal LFTs in the outpatient setting in patients with HFREF was associated with higher mortality in this study. Low Albumin was independently associated with mortality and length of hospital stay due to heart failure. An elevated alkaline phosphatase also seems to be important in predicting length of stay in hospital. Triaging acute heart failure patients due to Left Ventricular Systolic Dysfunction (LVSD) using abnormal LFTs as biomarkers for more intensive treatment and monitoring would seem advisable. However, this is a retrospective analysis of a relatively small number of patients and the conclusions must be seen in that light.

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“…This is different to previous studies, which have found some correlation between bilirubin with death [11][12][13].…”

Section: Discussioncontrasting

confidence: 99%

Association of Abnormal Liver Function Tests to Outcomes in Patients with a New Diagnosis of Heart Failure with Reduced Ejection Fraction in the Outpatient Clinic

Koganti¹,

DasGupta²,

Crossman³

et al. 2017

J Cardiovasc Dis Diagn

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“…[6][7][8][9][10][11][12][13][14] ). Concerning T-BIL, according Shinigava et al the prevalence of abnormal serum levels was much higher (64%) compared to work of Lau et al (19%) and this study (34%).…”

Section: Discussionmentioning

confidence: 99%

“…Of transaminases, prevalence of abnormal levels of AST and ALT in our study was higher than previously reported (42% and 35%, respectivelycompared to 33% and 25% in study of Nikolau et al and 4% and 7% in study of Lau et al, respectively) (ref. 7,11,14 ). Lower prevalence of abnormal transaminases in Lau's work was caused by exclusion of acute myocardial infarction patients from the study.…”

Section: Discussionmentioning

confidence: 99%

“…Strikingly, there are only few works investigating the liver involvement in AHF (Table 1) (ref. [6][7][8][9][10][11][12][13][14]. The aim of this study was to evaluate the prevalence of LFTs abnormalities and to identify associated cardiac and noncardiac factors mediating hepatic impairment in AHF -new onset (de novo) heart failure as well as acute exacerbation of chronic.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence and clinical significance of liver function abnormalities in patients with acute heart failure

Vyskočilová¹,

Špinarová²,

Špinar³

et al. 2015

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Aims. Liver pathology caused by cardiac dysfunction is relatively well recognized, however, its clinical importance has not been fully evaluated. The aim of this study was to assess the prevalence of liver function tests (LFTs) abnormalities and to identify associated factors mediating hepatic impairment in patients with acute heart failure (AHF). Methods. The AHEAD (Acute Heart Failure Database) registry is a database conducted in 9 university hospitals and 5 regional health care facilities in the Czech Republic. From December 2004 to October 2012, the data of 8818 patients were included. The inclusion criteria for the database followed the European guidelines for AHF. Serum activities of all LFTs and total bilirubin were available in 1473 patients at the baseline. Results. In patients with AHF, abnormal LFTs were seen in 76% patients (total bilirubin in 34%, γ-glutamyltransferase in 44%, alkaline phosphatase in 20%, aspartate aminotransferase in 42%, alanine aminotransferase in 35%). Patients with cardiogenic shock were more likely to have LFTs abnormalities compared to mild AHF and pulmonary oedema. LFTs abnormalities were strongly associated with AHF severity (left ventricular ejection fraction and NYHA functional class) and clinical manifestation. While hepatocellular LFTs pattern predominated in left sided forward AHF, cholestatic profile occurred mainly in bilateral and right sided AHF. Additionally, patients with moderate to severe tricuspid regurgitation had significantly higher prevalence of abnormalities in cholestatic LFTs. Conclusions. Defining the LFTs profile typical for AHF plays an important role in management of AHF patients, since it may avoid redundant hepatic investigations and diagnostic misinterpretations.

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“…It has been shown that bilirubin is independently associated with morbidity and mortality. [4][5][6][7][8] Changes in total bilirubin levels may offer insight into the underlying pathophysiology of chronic HF. 4) Furthermore, looking at the relationship between liver dysfunction and exercise capacity, the 6-minute walking distance (6MD) increased significantly after liver transplantation, compared with the pre-transplantation value.…”

Section: Introductionmentioning

confidence: 99%

Association Between Liver Function and Peak Oxygen Uptake in Heart Failure Patients: A Retrospective Observational Study

Hanada¹,

Kudo

Kanzaki³

et al. 2017

PRM

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Objective: With respect to liver function and heart failure, 46% of acute decompensated heart failure patients exhibit abnormal liver function. However, there have been no reports of the association between liver function and functional capacity in these patients. Our aim was to clarify the relationship between liver function and functional capacity using the peak oxygen uptake (VO 2 ). Methods: We retrospectively identified 36 heart failure patients who were referred to our rehabilitation laboratory. These patients underwent cardiopulmonary exercise testing (CPX). Furthermore, we investigated the correlations between peak VO 2 , blood measurements [e.g., total bilirubin (T-bil) and brain natriuretic peptide], and echocardiographic parameters. Finally, multivariate regression analysis was performed to investigate the independent variables related to peak VO 2 . Results: The mean peak VO 2 was 10.7±2.9 ml/kg/min. Peak VO 2 during CPX correlated inversely with T-bil [r=-0.379, 95% confidence intervals (CI): −0.654 to −0.014, P=0.043], aspartate transaminase (r=-0.426, 95% CI: −0.685 to −0.07, P=0.021), and peak heart rate (r=0.391, 95% CI: 0.029 to 0.663, P=0.036). The significant independent factors associated with peak VO 2 were treatment with statin (β=-3.19, P=0.015) and T-bil levels (β=-4.27, P=0.002). Conclusion: Our findings demonstrated that liver function may contribute to the functional capacity in heart failure patients.

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Prognostic Significance of Increased Serum Bilirubin Levels Coincident With Cardiac Decompensation in Chronic Heart Failure

Cited by 103 publications

References 15 publications

Association of Abnormal Liver Function Tests to Outcomes in Patients with a New Diagnosis of Heart Failure with Reduced Ejection Fraction in the Outpatient Clinic

Association of Abnormal Liver Function Tests to Outcomes in Patients with a New Diagnosis of Heart Failure with Reduced Ejection Fraction in the Outpatient Clinic

Prevalence and clinical significance of liver function abnormalities in patients with acute heart failure

Association Between Liver Function and Peak Oxygen Uptake in Heart Failure Patients: A Retrospective Observational Study

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