Liver dysfunction in chronic heart failure: prevalence, characteristics and prognostic significance

Poelzl, Gerhard; Ess, Michael; Mussner-Seeber, Christine; Pachinger, Otmar; Frick, Matthias; Ulmer, Hanno

doi:10.1111/j.1365-2362.2011.02573.x

Cited by 158 publications

(125 citation statements)

References 41 publications

Supporting

Mentioning

118

Contrasting

Unclassified

Order By: Relevance

“…In a study that evaluated patients with acute decompensated heart failure, 36.1% had an elevated bilirubin level 28. In another study that involved ambulatory patients with heart failure, bilirubin was elevated in 15.2% of patients 29. Although it is conceivable that the prevalence of ductal enzyme elevation varies in different cardiac conditions, our study revealed that almost half of the patients with TR awaiting TA had an elevated bilirubin level (49%).…”

Section: Discussionmentioning

confidence: 47%

Prognostic Value of Hepatorenal Function By Modified Model for End‐stage Liver Disease (MELD) Score in Patients Undergoing Tricuspid Annuloplasty

Chen

Liu

Seto

et al. 2018

JAHA

View full text Add to dashboard Cite

BackgroundThe Model for End‐stage Liver Disease excluding international normalized ratio (MELD‐XI) score and the modified MELD score with albumin replacing international normalized ratio (MELD‐Albumin) score, which reflect both liver and renal function, have been reported as predictors of adverse events in liver and heart disease. Nonetheless, their prognostic value in patients undergoing tricuspid annuloplasty has not been addressed.Methods and ResultsA total of 394 patients who underwent tricuspid annuloplasty were evaluated. Baseline clinical, laboratory, and echocardiographic parameters were recorded. Adverse outcome was defined as the occurrence of heart failure requiring admission or all‐cause mortality. Patients who underwent tricuspid annuloplasty had a high prevalence of preoperative hepatorenal dysfunction that was more common in patients with severe tricuspid regurgitation than those with mild to moderate tricuspid regurgitation. The MELD‐XI and MELD‐Albumin scores were excellent predictors of 1‐year adverse outcome (area under the curve: 0.69 and 0.75, respectively). Kaplan–Meier survival curve demonstrated that a high score on MELD‐XI (≥12.0) and MELD‐Albumin (≥10.7) was associated with an increased risk of adverse events. During a median follow‐up of 40 months, both MELD‐XI and MELD‐Albumin scores were significantly associated with adverse outcome, even after adjusting for potential confounding factors. Significant improvement of hepatorenal function at 1 year postoperation was noted only in patients who had no adverse events, not in those who experienced an adverse outcome.ConclusionsBoth MELD‐XI score and MELD‐Albumin score can provide useful information to predict adverse outcome in patients undergoing tricuspid annuloplasty. The present study supports monitoring of modified MELD score to improve preoperative risk stratification of these patients.

show abstract

Section: Discussionmentioning

confidence: 47%

Prognostic Value of Hepatorenal Function By Modified Model for End‐stage Liver Disease (MELD) Score in Patients Undergoing Tricuspid Annuloplasty

Chen

Liu

Seto

et al. 2018

JAHA

View full text Add to dashboard Cite

show abstract

“…In addition, in the current study DILIsym was not parameterized for heart failure patients. While liver function test (LFT) abnormalities are common in heart failure patients, little is currently known about the effects of heart failure on hepatic function 19, 20, 21. In the current study the subjects had normal baseline LFTs.…”

Section: Discussionmentioning

confidence: 87%

Refining Liver Safety Risk Assessment: Application of Mechanistic Modeling and Serum Biomarkers to Cimaglermin Alfa (GGF2) Clinical Trials

Longo

Generaux

Howell

et al. 2017

Clin Pharma and Therapeutics

View full text Add to dashboard Cite

Cimaglermin alfa (GGF2) is a recombinant human protein growth factor in development for heart failure. Phase I trials were suspended when two cimaglermin alfa‐treated subjects experienced concomitant elevations in serum aminotransferases and total bilirubin, meeting current US Food and Drug Administration criteria for a serious liver safety signal (i.e., “Hy's Law”). We assayed mechanistic biomarkers in archived clinical trial serum samples which confirmed the hepatic origin of the aminotransferase elevations in these two subjects and identified apoptosis as the major mode of hepatocyte death. Using a mathematical model of drug‐induced liver injury (DILIsym) and a simulated population, we estimated that the maximum hepatocyte loss in these two subjects was <13%, which would not result in liver dysfunction sufficient to significantly increase serum bilirubin levels. We conclude that the two subjects should not be considered Hy's Law cases and that mechanistic biomarkers and modeling can aid in refining liver safety risk assessment in clinical trials.

show abstract

“…This can be explained by hepatic congestion due to increased venous pressure resulting in cholestasis and elevated ALP and Bilirubin. However elevated cholestatic enzymes in the absence of right heart involvement is puzzling although this was noted in the study carried out by Poelzl et al [17]. In their cohort consisting of 1032 patients with chronic heart failure the predominant abnormality was elevation in cholestatic enzymes.…”

Section: Discussionmentioning

confidence: 82%

Association of Abnormal Liver Function Tests to Outcomes in Patients with a New Diagnosis of Heart Failure with Reduced Ejection Fraction in the Outpatient Clinic

Koganti¹,

DasGupta²,

Crossman³

et al. 2017

J Cardiovasc Dis Diagn

View full text Add to dashboard Cite

Aim: To evaluate the relationship of abnormal Liver Function Tests (LFTs) to outcomes in patients with heart failure due to reduced ejection fraction (HFREF) at the time of diagnosis in the heart failure clinic. Methods:We undertook a retrospective analysis of all patients diagnosed with HFREF in the heart failure outpatient clinic of a tertiary teaching hospital from 2007 to 2011. Ninety-five patients with abnormal LFTs at presentation were compared with 127 contemporaneous randomly chosen patients with normal LFTs and their outcomes were analyzed. Time to event data mortality and admission rates, as well as length of hospital stay during admissions were assessed. Results:Of 222 patients 69% were Male. The mean age across both the groups was 69.2 ± 13.2 years. The major ethnic group was of white background (78%). Majority of patients were in NYHA class 2 (54.5%). On multivariate analysis, low albumin at the time of diagnosis was the strongest predictor of all cause death (OR 1.24, 95% CI 1.15-1.35, p<0.0001). Patients in the abnormal LFT group had a longer in-hospital stay compared to those in the normal LFT group (25.9 ± 29.1 days vs. 17.2 ± 20.5 days, p=0.01). Low albumin and elevated alkaline phosphatase (ALP) were the strongest predictors of increased length of in-hospital stay following heart failure related admissions on multivariate analysis (OR -0.583, CI -1.119, -0.046, p=0.035 and OR 0.033, CI 0.005, 0.061, p=0.02, respectively). Every unit increase of albumin resulted in reduction of in hospital stay by 0.875 days. Time to event analysis showed more deaths in the abnormal LFT group when compared to the normal LFT group (log rank test p=0.012). Although an elevated ALP was seen to be associated with readmission, multivariate analysis found this to be a trend only, with none of the LFTs being predictive. Conclusion:Abnormal LFTs in the outpatient setting in patients with HFREF was associated with higher mortality in this study. Low Albumin was independently associated with mortality and length of hospital stay due to heart failure. An elevated alkaline phosphatase also seems to be important in predicting length of stay in hospital. Triaging acute heart failure patients due to Left Ventricular Systolic Dysfunction (LVSD) using abnormal LFTs as biomarkers for more intensive treatment and monitoring would seem advisable. However, this is a retrospective analysis of a relatively small number of patients and the conclusions must be seen in that light.

show abstract

Liver dysfunction in chronic heart failure: prevalence, characteristics and prognostic significance

Abstract: Liver dysfunction is frequent in CHF and characterized by a predominantly cholestatic enzyme profile that is associated with disease severity and prognosis. Thus, we propose a cardio-hepatic syndrome in CHF. Future studies are needed to clarify the exact mechanisms of organ interaction.

Cited by 158 publications

References 41 publications

Prognostic Value of Hepatorenal Function By Modified Model for End‐stage Liver Disease (MELD) Score in Patients Undergoing Tricuspid Annuloplasty

Prognostic Value of Hepatorenal Function By Modified Model for End‐stage Liver Disease (MELD) Score in Patients Undergoing Tricuspid Annuloplasty

Refining Liver Safety Risk Assessment: Application of Mechanistic Modeling and Serum Biomarkers to Cimaglermin Alfa (GGF2) Clinical Trials

Association of Abnormal Liver Function Tests to Outcomes in Patients with a New Diagnosis of Heart Failure with Reduced Ejection Fraction in the Outpatient Clinic

Contact Info

Product

Resources

About