Abstract
Abnormal liver function tests (LFTs) are known to be associated with impaired clinical outcomes in heart failure (HF) patients. However, this implication varies with each single LFT panel. We aim to evaluate the long-term outcomes of acute HF (AHF) patients by assessing multiple LFT panels in combination. From a prospective multicenter registry in Japan, 1158 AHF patients who were successfully discharged were analyzed (mean age, 73.9 ± 13.5 years; men, 58%). LFTs (i.e., total bilirubin, aspartate aminotransferase or alanine aminotransferase, and alkaline phosphatase) at discharge were assessed; borderline and abnormal LFTs were defined as 1 and ≥2 parameter values above the normal range, respectively. The primary endpoint was composite of all-cause death or HF readmission. At the time of discharge, 28.7% and 8.6% of patients showed borderline and abnormal LFTs, respectively. There were 196 (16.9%) deaths and 298 (25.7%) HF readmissions during a median 12.4-month follow-up period. The abnormal LFTs group had a significantly higher risk of experiencing the composite outcome (adjusted hazard ratio: 1.51, 95% confidence interval: 1.08–2.12, p = 0.017), whereas the borderline LFTs group was not associated with higher risk of adverse events when referenced to the normal LFTs group. Among AHF patients, the combined elevation of ≥2 LFT panels at discharge was associated with long-term adverse outcomes.
Highlights
Liver dysfunction mediated by hemodynamic instability is known to be present in 20–40% of patients with acute heart failure (AHF) [1,2,3]
This study analyzed data from the West Tokyo Heart Failure (WET-HF) registry, This study analyzed data from the West Tokyo Heart Failure (WET-HF) registry, which which consecutively registered patients hospitalized for AHF in 6 tertiary care centers in consecutively registered patients hospitalized for AHF in 6 tertiary care centers in the the Tokyo metropolitan area
To comprehensively evaluate hepatic function, we focused on the above three parameters and categorized the patients into the following three groups: the normal liver function tests (LFTs) group, the borderline LFT group, and the abnormal LFT group
Summary
Liver dysfunction mediated by hemodynamic instability (cardiohepatic interaction) is known to be present in 20–40% of patients with acute heart failure (AHF) [1,2,3]. Analyses from large-scale randomized controlled trials have demonstrated that abnormal values of liver function tests (LFTs) are associated with increased morbidity and mortality in patients with heart failure (HF) [4,5]. Previous studies have focused largely on a single abnormality of LFTs, such as total bilirubin (TB), aspartate aminotransferase (AST) or alanine aminotransferase (ALT), and alkaline phosphatase (ALP), which may be elevated due to factors other than hemodynamic instability (e.g., drug-induced liver injury, physiological jaundice, and malnutrition). The assessment of LFTs in combination, rather than any single parameter, may be more useful for clear decision-making with regard to risk stratification and the tailoring of treatment for HF. There has been no consensus on the type of LFT derangements that is directly
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