Prognostic value of cardio-hepatic-skeletal muscle syndrome in patients with heart failure

Takumi Noda,Emi Maekawa,Junya Ako,Takeshi Nakamura,Kentaro Kamiya,Shota Uchida,Takafumi Ichikawa,Kohei Nozaki,Masashi Yamashita,Minako Yamaoka-Tojo,Atsuhiko Matsunaga,Nobuaki Hamazaki,Jennifer L Reed

doi:10.1038/s41598-020-80641-2

Abstract

Although heart failure (HF) and liver dysfunction often coexist because of complex cardiohepatic interactions, the association between liver dysfunction and physical dysfunction, and between coexistence of both and prognosis in HF patients remains unclear. We reviewed 895 patients with HF (mean age, 69.4 ± 14.2 years) who underwent liver function test using model for end-stage liver disease excluding international normalized ratio (MELD-XI) score and physical function test (grip strength, leg strength, gait speed, and 6-min walking distance [6MWD]). In the multiple regression analysis, MELD-XI score was independently associated with lower grip strength, leg strength, gait speed, and 6MWD (all P < 0.001). One hundred thirty deaths occurred over a median follow-up period of 1.67 years (interquartile range: 0.62–3.04). For all-cause mortality, patients with high MELD-XI scores and reduced physical functions were found to have a significantly higher mortality risk even after adjusting for several covariates (grip strength, hazard ratio [HR]: 3.80, P < 0.001; leg strength, HR: 4.65, P < 0.001; gait speed, HR: 2.49, P = 0.001, and 6MWD, HR: 5.48, P < 0.001). Liver dysfunction was correlated with reduced physical function. Moreover, the coexistence of lower physical function and liver dysfunction considerably affected prognosis in patients with HF.

Highlights

Heart failure (HF) and liver dysfunction often coexist because of complex cardiohepatic interactions, the association between liver dysfunction and physical dysfunction, and between coexistence of both and prognosis in heart failure (HF) patients remains unclear
In the present study, B-type natriuretic peptide (BNP) and NYHA, which are related to the severity of HF, were shown to be related to physical dysfunction, similar to the model for end-stage liver disease (MELD)-XI score. These results suggest that the coexistence of liver dysfunction and high severity of HF has a strong impact on reduced physical function
Our study demonstrated that the complications of liver and physical dysfunction exacerbate the prognosis of patients with HF

Summary

Introduction

Heart failure (HF) and liver dysfunction often coexist because of complex cardiohepatic interactions, the association between liver dysfunction and physical dysfunction, and between coexistence of both and prognosis in HF patients remains unclear. We reviewed 895 patients with HF (mean age, 69.4 ± 14.2 years) who underwent liver function test using model for end-stage liver disease excluding international normalized ratio (MELD-XI) score and physical function test (grip strength, leg strength, gait speed, and 6-min walking distance [6MWD]). For all-cause mortality, patients with high MELD-XI scores and reduced physical functions were found to have a significantly higher mortality risk even after adjusting for several covariates (grip strength, hazard ratio [HR]: 3.80, P < 0.001; leg strength, HR: 4.65, P < 0.001; gait speed, HR: 2.49, P = 0.001, and 6MWD, HR: 5.48, P < 0.001). Abbreviations BMI Body mass index BNP B-type natriuretic peptide CI Confidence interval HF Heart failure HR Hazard ratio IQR Interquartile range LVEF Left ventricular ejection fraction MELD-XI Model for end-stage liver disease excluding international normalized ratio NYHA New York Heart Association PT-INR Prothrombin time-international normalized ratio 6MWD 6-Min walking distance. This study was performed to examine whether the severity of liver dysfunction in patients with HF is associated with decreased physical function, and to investigate the prognostic impact of combined liver and motor dysfunction in patients with HF

Methods

Results

Discussion

Conclusion