Yuya Matsue1, Nobuyuki Kagiyama2, Tetsuo Yamaguchi3, Shunsuke Kuroda4, Takahiro Okumura5, Keisuke Kida6, Atsushi Mizuno7, Shogo Oishi8, Yasutaka Inuzuka9, Eiichi Akiyama10, Ryuichi Matsukawa11, Kota Kato12, Satoshi Suzuki13, Takashi Naruke14, Kenji Yoshioka4, Tatsuya Miyoshi15, Yuichi Baba16, Masayoshi Yamamoto17, Kazuo Mizutani18, Kazuki Yoshida19, Takeshi Kitai20. 1. Department of Cardiology, Juntendo University and Cardiovascular, Tokyo, Japan; Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan. 2. Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan; Heart and Vascular Institute, West Virginia University, WV, USA. Electronic address: kgnb_27_hot@yahoo.co.jp. 3. Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan. 4. Department of Cardiology, Kameda Medical Center, Chiba, Japan. 5. Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan. 6. Department of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan. 7. Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan. 8. Department of Cardiology, Himeji Cardiovascular Center, Himeji, Japan. 9. Department of Cardiology, Shiga Medical Center for Adults, Moriyama, Japan. 10. Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan. 11. Division of Cardiology, Cardiovascular and Aortic Center, Saiseikai Fukuoka General Hospital, Fukuoka, Japan. 12. Department of Cardiology, Tokyo Medical University, Tokyo, Japan. 13. Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan. 14. Department of Cardiovascular Medicine, Kitasato University School of Medicine, Tokyo, Japan. 15. Department of Cardiology, Ako City Hospital, Ako, Japan. 16. Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan. 17. Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. 18. Department of Cardiology, Kobe Century Memorial Hospital, Kobe, Japan. 19. Departments of Epidemiology & Biostatistics, Harvard T.H. Chan School of Public Health, Boston, USA. 20. Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan; Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Abstract
BACKGROUND: Although liver dysfunction is one of the common complications in patients with acute heart failure (AHF), no integrated marker has been defined. The albumin-bilirubin (ALBI) score has recently been proposed as a novel, clinically-applicable scoring system for liver dysfunction. We investigated the utility of the ALBI score in patients with AHF compared to that for a preexisting liver dysfunction score, the Model of End-Stage Liver Disease Excluding prothrombin time (MELD XI) score. METHODS: We evaluated ALBI and MELD XI scores in 1,190 AHF patients enrolled in the prospective, multicentre Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure study. The associations between the two scores and the clinical profile and prognostic predictive ability for 1-year mortality were evaluated. RESULTS: The mean MELD XI and ALBI scores were 13.4±4.8 and -2.25±0.48, respectively. A higher ALBI score, but not higher MELD XI score, was associated with findings of fluid overload. After adjusting for pre-existing prognostic factors, the ALBI score (HR 2.11, 95% CI: 1.60-2.79, p<0.001), but not the MELD XI score (HR 1.02, 95% CI: 0.99-1.06, p=0.242), was associated with 1-year mortality. Likewise, area under the receiver-operator-characteristic curves for 1-year mortality significantly increased when the ALBI score (0.71 vs. 0.74, p=0.020), but not the MELD XI score (0.71 vs. 0.72, p=0.448), was added to the pre-existing risk factors. CONCLUSIONS: The ALBI score is potentially a suitable liver dysfunction marker that incorporates information on fluid overload and prognosis in patients with AHF. These results provide new insights into heart-liver interactions in AHF patients.
BACKGROUND: Although liver dysfunction is one of the common complications in patients with acute heart failure (AHF), no integrated marker has been defined. The albumin-bilirubin (ALBI) score has recently been proposed as a novel, clinically-applicable scoring system for liver dysfunction. We investigated the utility of the ALBI score in patients with AHF compared to that for a preexisting liver dysfunction score, the Model of End-Stage Liver Disease Excluding prothrombin time (MELD XI) score. METHODS: We evaluated ALBI and MELD XI scores in 1,190 AHFpatients enrolled in the prospective, multicentre Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure study. The associations between the two scores and the clinical profile and prognostic predictive ability for 1-year mortality were evaluated. RESULTS: The mean MELD XI and ALBI scores were 13.4±4.8 and -2.25±0.48, respectively. A higher ALBI score, but not higher MELD XI score, was associated with findings of fluid overload. After adjusting for pre-existing prognostic factors, the ALBI score (HR 2.11, 95% CI: 1.60-2.79, p<0.001), but not the MELD XI score (HR 1.02, 95% CI: 0.99-1.06, p=0.242), was associated with 1-year mortality. Likewise, area under the receiver-operator-characteristic curves for 1-year mortality significantly increased when the ALBI score (0.71 vs. 0.74, p=0.020), but not the MELD XI score (0.71 vs. 0.72, p=0.448), was added to the pre-existing risk factors. CONCLUSIONS: The ALBI score is potentially a suitable liver dysfunction marker that incorporates information on fluid overload and prognosis in patients with AHF. These results provide new insights into heart-liver interactions in AHFpatients.
Authors: Maoning Lin; Jiachen Zhan; Yi Luan; Duanbin Li; Yu Shan; Tian Xu; Guosheng Fu; Wenbin Zhang; Min Wang Journal: Front Cardiovasc Med Date: 2022-05-11