Vincent M van Deursen1, Christopher Edwards2, Gad Cotter2, Beth A Davison2, Kevin Damman1, John R Teerlink3, Marco Metra4, G Michael Felker5, Piotr Ponikowski6, Elaine Unemori7, Thomas Severin8, Adriaan A Voors9. 1. Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. 2. Momentum Research, Durham, North Carolina. 3. Section of Cardiology, San Francisco Veterans Affairs Medical Center, University of California, San Francisco, California. 4. Section of Cardiovascular Diseases, Department of Experimental and Applied Sciences, University of Brescia, Brescia, Italy. 5. Duke Clinical Research Institute, Duke University, Durham, North Carolina. 6. Cardiology Department, Military Hospital, Department of Health Sciences, Medical University, Wroclaw, Poland. 7. Corthera, San Mateo, California. 8. Novartis Pharma, Basel, Switzerland. 9. Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. Electronic address: a.a.voors@umcg.nl.
Abstract
BACKGROUND: Elevated plasma concentrations of liver function tests are prevalent in patients with chronic heart failure (HF). Little is known about liver function in patients with acute HF. We aimed to assess the prevalence and prognostic value of serial measurements of liver function tests in patients admitted with acute decompensated HF. METHODS: We investigated liver function tests from all 234 patients from the Relaxin for the Treatment of Patients With Acute Heart Failure study at baseline and during hospitalization. The end points were worsening HF through day 5, 60-day mortality or rehospitalization, and 180-day mortality. RESULTS:Mean age was 70 ± 10 years, 56% were male, and most patients were in New York Heart Association functional class III/IV (73%). Abnormal liver function tests were frequently found for alanine transaminase (ALT; 12%), aspartate transaminase (AST; 21%), alkaline phosphatase (12%), and total bilirubin (19%), and serum albumin (25%) and total protein (9%) were decreased. In-hospital changes were very small. On a continuous scale, baseline ALT and AST were associated with 180-day mortality (hazard ratios [HRs; per doubling] 1.52 [P = .030] and 1.97 [P = .013], respectively) and worsening HF through day 5 (HRs [per doubling] 1.72 [P = .005] and 1.95 [P = .008], respectively). Albumin was associated with 180-day mortality (HR 0.86; P = .001) but not with worsening HF (HR 0.95; P = .248). Total protein was associated with only worsening HF (HR 0.91; P = .004). CONCLUSIONS:Abnormal liver function tests are often present in patients with acute HF and are associated with an increased risk for mortality, rehospitalization, and in-hospital worsening HF.
RCT Entities:
BACKGROUND: Elevated plasma concentrations of liver function tests are prevalent in patients with chronic heart failure (HF). Little is known about liver function in patients with acute HF. We aimed to assess the prevalence and prognostic value of serial measurements of liver function tests in patients admitted with acute decompensated HF. METHODS: We investigated liver function tests from all 234 patients from the Relaxin for the Treatment of Patients With Acute Heart Failure study at baseline and during hospitalization. The end points were worsening HF through day 5, 60-day mortality or rehospitalization, and 180-day mortality. RESULTS: Mean age was 70 ± 10 years, 56% were male, and most patients were in New York Heart Association functional class III/IV (73%). Abnormal liver function tests were frequently found for alanine transaminase (ALT; 12%), aspartate transaminase (AST; 21%), alkaline phosphatase (12%), and total bilirubin (19%), and serum albumin (25%) and total protein (9%) were decreased. In-hospital changes were very small. On a continuous scale, baseline ALT and AST were associated with 180-day mortality (hazard ratios [HRs; per doubling] 1.52 [P = .030] and 1.97 [P = .013], respectively) and worsening HF through day 5 (HRs [per doubling] 1.72 [P = .005] and 1.95 [P = .008], respectively). Albumin was associated with 180-day mortality (HR 0.86; P = .001) but not with worsening HF (HR 0.95; P = .248). Total protein was associated with only worsening HF (HR 0.91; P = .004). CONCLUSIONS:Abnormal liver function tests are often present in patients with acute HF and are associated with an increased risk for mortality, rehospitalization, and in-hospital worsening HF.
Authors: Daniel Dalos; Christina Binder; Franz Duca; Stefan Aschauer; Andreas Kammerlander; Christian Hengstenberg; Julia Mascherbauer; Thomas Reiberger; Diana Bonderman Journal: Sci Rep Date: 2019-12-06 Impact factor: 4.379
Authors: Mahmoud El Iskandarani; Bara El Kurdi; Ghulam Murtaza; Timir K Paul; Marwan M Refaat Journal: Medicine (Baltimore) Date: 2021-03-12 Impact factor: 1.817