Current literature suggests an increased incidence of rhabdomyolysis in patients with chronic liver disease (CLD) compared to the general population. We present a case of a 60-year-old female with a history of non-alcoholic fatty liver disease and cirrhosis who developed rhabdomyolysis and acute kidney injury after starting high-intensity atorvastatin therapy. This case highlights the potential risks associated with high-intensity statin therapy in patients with CLD, particularly those with advanced liver dysfunction, emphasizing the need for cautious prescribing and thorough risk-benefit assessment in this vulnerable patient population.
Background:
Raised BNP/NT-pro BNP has been reported as a poor prognostic indicator in hypertrophic cardiomyopathy (HCM) patients. However, the unavailability of pooled data utilizing BNP/NT-proBNP as a prognostic biomarker led us to perform this systematic review and meta-analysis.
Methods:
Using relevant keywords, PubMed/Medline, Scopus, and EMBASE were systematically reviewed to evaluate studies reporting all-cause mortality or sudden death with BNP/NT-pro BNP through May 2022. Random effects models and I
2
statistics were used for pooled hazard ratios (HR) and heterogeneity assessment using Review Manager (RevMan) [Computer program]. Version 5.4, The Cochrane Collaboration, 2020.
Results:
Our systematic review included sample size of 6691 from 12 studies [Table 1]. Four publications were from China, 2 from Japan and Turkey each and 1 from USA, UK, Italy and France each. Age ranged from 46-55 years with a follow up time from 3-8 years. High NT-proBNP was associated with significantly high risk of all-cause mortality in both unadjusted (HR 1.69, 95%CI: 1.30-2.20, p<0.05, I
2
=90%) and adjusted models (HR 3.73, 95%CI: 1.36-10.21, p<0.05, I
2
=83%), and of sudden death in adjusted (HR 4.78, 95%CI: 1.49-15.34, p<0.05, I
2
=89%). Raised BNP level was associated with adjusted sudden death (HR 5.10, 95%CI: 3.03-8.61, p<0.05)
(Fig. 1).
Conclusions:
This meta-analysis suggested that higher BNP/NT-proBNP level was associated with high risk of combined all-cause mortality and sudden death in patient with hypertrophic cardiomyopathy.
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