BPS 02–15 HIGHER INCIDENCE OF CARDIOHEPATIC SYNDROME IN PATIENTS WITH DECOMPENSATED HEART FAILURE AND ACUTE KIDNEY INJURY

Abstract

Objective: Liver and kidney dysfunction is frequently encountered in heart failure and related to worse prognosis. Over the last several years interdependent feedback mechanisms involving the heart, kidney and liver have been discussed. The aim of the study was to assess the prevalence of acute kidney injury (AKI) and abnormal liver function tests (LFT) and their interrelations in acute decompensated heart failure (ADHF). Design and Method: In 322 ADHF patients (190 male, 69.5 ± 10.6years (M ± SD), arterial hypertension 87%, myocardial infarction 57%, atrial fibrillation 65%, diabetes mellitus 42%, known chronic kidney disease (CKD) 39%, chronic anemia 29%, ejection fraction (EF)38 ± 13%, EF <35% 39.1%) alanine transaminase (ALT), aspartate transaminase (AST), direct and total bilirubin (DB and TB), alkaline phosphatase (AP), gamma-glutamyl transpeptidase (GGT) and international normalized ratio (INR) were measured on admission. LFT were considered abnormal when levels exceeded local upper normal limit. Patients on warfarin were excluded from INR analysis. AKI was diagnosed based on KDIGO2012Guidelines. Mann-Whitney test and multivariate logistic regression analysis were performed, p < 0.05 was considered statistically significant. Results: Abnormal LFTs occurred in 274 (85.1%) patients. Increase of transaminases were detected in 68 (21.1%) patients (alone ALT/alone AST/both TA in 35.3, 26.5, 38.2% respectively), DB and/or TB in 264 (82%) patients (alone DB/alone TB/DB and TB – in 28, 0.8, 71.2% respectively), AP in 90 (27.9%) and GGT in 102 (31.7%) patients. AKI was diagnosed in 60 (18.6%) patients. Patients with versus without AKI had higher levels of ALT (60 ± 88 vs 29 ± 26U/l, p < 0.05), AST (52 ± 45 vs 31 ± 16U/l, p < 0.001), TB (29 ± 13 vs 25 ± 15 μmol/l, p < 0.01), DB (12 ± 7 vs 9 ± 7 μmol/l, p < 0.001), GGT (157 ± 117 vs 102 ± 68U/l, p < 0.001), AP (124 ± 74 vs 112 ± 88 U/l, p < 0.05), INR (1.49 ± 0.42 vs 1.29 ± 0.23, p < 0.01). Patients with vs without AKI had higher prevalence of increase of ALT (30 vs 12.3%, p < 0,001), AST (33.3 vs 9.2%, p < 0,001), TB (73.3 vs 56.2%, p < 0.05) and INR (60.8% vs 43.8%, p < 0,05). AKI was predictor for increase of ALT (OR 3.1,95%CI 1.6–5.9), AST (OR 4.9, CI 2.5–9.7), TB (OR2.1, CI1.2–4.0) and INR (OR 2.0, CI 1.0–3.9). Conclusions: Abnormal LFTs occurred in 85.1%, AKI-in 18.6% of patients admitted with ADHF. Patients with versus without AKI had higher prevalence of abnormal LFTs. In patients with ADHF increase of transaminases, total bilirubin and INR can directly contribute to AKI and vice versa.