The importance of abnormalities of liver function tests in predicting mortality in chronic heart failure

Batin, Phillip D; Wickens, Mark; McEntegart, Damian; Fullwood, L.; Cowley, A. J.

doi:10.1093/oxfordjournals.eurheartj.a060785

Cited by 121 publications

(84 citation statements)

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“…17) RV was ignored or not considered to be important, but recently, RV function has drawn more attention according to the increase in advanced HF. A number of studies have shown it to be a strong predictor of a poor prognosis in HF using the gold standard as RV ejection fraction (RVEF) estimated by cardiovascular magnetic resonance imaging (CMR).…”

Section: Discussionmentioning

confidence: 99%

“…Likewise liver function tests were found to be abnormal only in patients with PH and RV dysfunction, reflecting either the greater hemodynamic derangement or, possibly, a longer duration of the RV overload. 54,55) Therefore, enlarged RVDd, which reveals RV dysfunction as determined using noninvasive methods and during emergencies, can be regarded as one of the LOS indicators, even in HF patients with LV dysfunction.…”

Section: )mentioning

confidence: 99%

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Prognostic Significance of Right Ventricular Dimension on Acute Decompensation in Chronic Left-Sided Heart Failure

et al. 2011

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SummaryRight ventricular (RV) dysfunction has been discussed in relation to an adverse outcome in heart failure (HF). The aim of this study was to analyze the relationship between RV function with HF exacerbation and its subsequent longterm outcome in patients with chronic left-sided HF.We studied 122 consecutive patients who were admitted for dyspnea due to exacerbated left-sided HF with a left ventricular (LV) ejection fraction of less than 40%. Conventional echocardiography was performed in the study subjects on admission and at discharge. Cox proportional hazards analysis revealed that RV end-diastolic dimension (RVDd) (hazard ratio 1.131, P = 0.005, 95% confidence interval 1.039-1.231) and the serum level of creatinine on admission were independent predictors of subsequent cardiac-related death, but RVDd at discharge and other LV parameters were not. Thus, patients were divided into tertiles on the basis of RVDd on admission: < 32 mm (n = 37), 32-40 mm (n = 43), and ≧ 40 mm (n = 42). According to the increase in the RVDd category, the cardiac-related death-free rate significantly decreased. Among the 3 groups, the pulse pressure and serum total bilirubin levels that demonstrated low cardiac output syndrome (LOS) parameters had significant differences.RVDd on admission could be measured noninvasively and easily to predict a worse long-term prognosis of chronic left-sided HF on admission, and showed correlations with LOS parameters. (Int Heart J 2011; 52: 119-126)

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Prognostic Significance of Right Ventricular Dimension on Acute Decompensation in Chronic Left-Sided Heart Failure

et al. 2011

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“…68,69 The prognostic importance of abnormalities in liver function tests (LFTs) has varied among published studies. The unfavourable predictive value of abnormal LFTs has been described in patients with chronic HF 70 or acute decompensated heart failure (ADHF). 71 Total bilirubin was among the most highly significant predictors of mortality in a post hoc analysis of a large cohort of chronic HF patients in a clinical trial.…”

Section: Figurementioning

confidence: 99%

To Study the Clinical Profile and Viral Markers (Hepatitis B and C) In Acute and Chronic Liver Disease

Saini¹

2017

jmscr

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“…Low albumin reflecting poor nutrition is often seen in patients with cardiac cachexia [7][8][9]. LFTs have previously been characterized in patients with chronic heart failure and correlated to outcomes [10]; However to date no information exists on the correlation of abnormal LFTs at the time of diagnosis of heart failure secondary to left ventricular systolic dysfunction (LVSD) in the outpatient setting (OP) to patient outcomes. The purpose of this study was to characterize LFTs in a cohort of patients newly diagnosed with HFREF in OP and to explore the impact they have on patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

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

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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.

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The importance of abnormalities of liver function tests in predicting mortality in chronic heart failure

Cited by 121 publications

References 0 publications

Prognostic Significance of Right Ventricular Dimension on Acute Decompensation in Chronic Left-Sided Heart Failure

Prognostic Significance of Right Ventricular Dimension on Acute Decompensation in Chronic Left-Sided Heart Failure

To Study the Clinical Profile and Viral Markers (Hepatitis B and C) In Acute and Chronic Liver Disease

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

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