Hyperbilirubinemia - useful non-cardiac parameter of biventricular failure and negative prognosis in acute heart failure patients

Abstract

Purpose: To identify the value of hyperbilirubinemia as a parameter of biventricular Heart Failure (HF) and prognostic marker and its relation to selected characteristics in general population of hospitalized Acute Heart Failure (AHF) patients. Methods: We used the data from SLOVASeZ, nationwide multicenter AHF survey with 860 consecutive patients enrolled in 11 hospitals throughout Slovakia during 3 months. Hyperbilirubinemia was defined as serum bilirubine ≥ 25 μmol/L at admission. We analysed forty-eight variables in relation to clinical manifestation of AHF in univariate analysis. Significantly associated parameters (p < 0.05) were subsequently entered into linear regression model for multivariate analysis. Results: Hyperbilirubinemia was present in 151 patients (17.5%). Patients with hyperbilirubinemia were more often rehospitalized due to AHF (22.9 vs. 13.7%, p = 0.008) and had higher in-hospital mortality (12.6 vs. 5.6%, p = 0.007). Hyperbilirubinemia was also an independent predictor of in-hospital mortality (p < 0.01). There were ten significant parameters associated with hyperbilirubinemia in univariate analysis. Hyperbilirubinemia was significantly more common in men (28.1 vs. 10.7%, p < 0.001) and in patients admitted with AHF due to dilated cardiomyopathy (39.5 vs. 17.8%, p < 0.001), edema (23.5 vs. 15.5%, p = 0.01), hepatomegaly (32.8 vs. 15.4%, p < 0.001), jugular venous distension (30.6 vs. 15.5%, p < 0.001), hypotension – systolic blood pressure < 100 mmHg (38.5 vs. 18.7%, p = 0.002). Hyperbilirubinemia was also more frequent in patients with hyponatremia – serum sodium < 135 mmoL/l (38.1 vs. 17.3%, p < 0.001), left ventricular systolic dysfunction – ejection fraction ≤ 40% (26.4 vs. 15.7%, p = 0.003), severe mitral regurgitation (28.3 vs. 18.1%, p < 0.05) and those treated with inotropes (48.9 vs. 18.3%, p < 0.001). Parameters independently associated with hyperbilirubinemia were male gender and hyponatremia (for both p < 0.001) as well as severe mitral regurgitation (p < 0.05). Conclusion: Hyperbilirubinemia is a frequent and routinely available parameter in AHF patients. It is a reliable predictor of rehospitalizations due to AHF and in-hospital mortality, which is more than twice higher in hyperbilirubinemic AHF patients. Hyperbilirubinemia is more often associated with characteristics of biventricular HF and hypoperfusion what makes it useful non-cardiac parameter in detection of worse prognosis of these patients.