Abnormal liver function tests in acute heart failure: relationship with clinical characteristics and outcome in the PROTECT study

Abstract

The LFTs comprised serial assessment of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and albumin at baseline and during follow-up (daily until discharge, on days 7 and 14). The prevalence of abnormal LFTs (above upper limit of normal for AST and ALT or below lower limit of normal for albumin) was: at baseline AST 20%, ALT 12%, albumin 40%; and at day 14: AST 15%, ALT 9%, albumin 26%. Abnormal LFTs at baseline were associated with a higher risk of in-hospital death with odds ratios [95% confidence interval (CI)] of 3.5 (1.7-7.3) for AST, 3.9 (1.8-8.4) for ALT, and 2.8 (1.3-5.9) for albumin (all P < 0.01). Abnormal baseline and discharge LFTs had an unfavourable impact on 180-day mortality with hazard ratios (95% CI) for baseline AST, ALT, and albumin of 1.3 (1.0

Urinary levels of novel kidney biomarkers and risk of true worsening renal function and mortality in patients with acute heart failure

“…Medical treatment can lead to an increase in serum creatinine in patients with HF and may also be protective in patients with concomitant WRF; however, it remains unclear whether treatment recommended in HF may affect an occurrence of true WRF and a release of novel urinary biomarkers. It is also advisable to arrange similar studies concerning other organ dysfunction, such as worsening liver function, as there is a possibility that other organ dysfunction episodes may be similarly true or false . Not every deterioration in organ biomarkers is related to genuine organ damage.…”

Organ dysfunction, injury and failure in acute heart failure: from pathophysiology to diagnosis and management. A review on behalf of the Acute Heart Failure Committee of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

“…Hepatic dysfunction is present in 20–30% of patients with AHF . Elevated liver enzymes portend a poor prognosis .…”

Multi‐organ dysfunction/injury on admission identifies acute heart failure patients at high risk of poor outcome

“…However, clinical consequences of this phenomenon are traditionally investigated placing a single organ dysfunction/injury in isolation, whereas multiple organs may indeed be affected at the same time. Only recently, we and others have documented the importance of the interaction between affected organs in AHF. Such an approach is commonly applied to critical care medicine with the concept of multi‐organ damage/failure as a major prognosticator used in decision‐making and therapeutic algorithms recommended in clinical practice…”