Abstract 20954: Abnormal Liver Function Tests Are Association With Adverse Outcomes in Acute Decompensated Heart Failure in the CARRESS Trial

Abstract

Introduction: Hepatic congestion with abnormal liver function tests (LFTs), including aspartate aminotransferase (AST), alanine aminotransferase (ALT) and total bilirubin (TBL) complicates acute decompensated heart failure (ADHF). The prognostic implication of abnormal LFTs in ADHF is less studied. Hypothesis: We hypothesized that abnormal LFTs would be associated with unfavorable outcomes in the Cardiorenal Rescue Study in Acute Decompensated Heart Failure (CARRESS) trial. Methods: Cox proportional hazards analysis was performed to assess the association between LFTs (AST, ALT and TBL) at baseline in the CARRESS trial with adverse clinical outcomes, including death, death or HF rehospitalization, and death or any rehospitalization. Correlation analysis was used to assess the relationship between baseline LFTs and BNP, a surrogate of cardiac filling pressures. Results: Among 188 patients (67.9 ± 12.8 years, 25% female), 15.4% died, 35.5% died or had a HF rehospitalization, and 53.8% died or were rehospitalized for any reason. Elevated TBL at baseline was associated with an increased risk of death or rehospitalization for any reason (HR 1.65 per each mg/dL increase in total TBL, 95% CI 1.15-2.38, P=0.007), and a TBL in the upper quartile (> 1.2 mg/dL) was associated with an increased risk of death or HF hospitalization (HR 1.96, 95% CI 1.11-3.45, P=0.02) (Figure). Total bilirubin and BNP at baseline were moderately correlated (r=0.34, P=0.007). There were also no significant associations for AST or ALT with any of the clinical outcomes (P>0.20 for all). Conclusion: Total bilirubin was independently associated with adverse events in ADHF and was also correlated with BNP, a marker of increased cardiac filling pressures. More studies are needed to better define the implications of abnormal LFTs in other HF phenotypes.