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[Prevalence and prognostic value of liver function abnormalities in patients with chronic systolic heart failure]
Sheng-bo Yu1, Hong-ying Cui, Mu Qin
1Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, China.
Insights
Liver function abnormalities are common in patients with chronic systolic heart failure (HF). High direct bilirubin, high total bilirubin, and low albumin are independent risk factors for mortality in these patients.
Area of Science:
- Cardiology
- Hepatology
- Internal Medicine
Context:
- Chronic systolic heart failure (HF) affects millions globally, often accompanied by secondary complications.
- Liver function abnormalities are frequently observed in HF patients but their prognostic significance requires further elucidation.
Purpose:
- To systematically evaluate the prevalence of liver function abnormalities in patients with chronic systolic heart failure (HF).
- To determine the prognostic value of these abnormalities on overall mortality.
- To explore correlations between cardiac function parameters and liver function markers.
Summary:
- This study analyzed 16,681 hospitalized patients with chronic systolic HF (left ventricular ejection fraction < 50%).
- Over a median 3-year follow-up, 38.69% of patients died. Liver function abnormalities were prevalent (71.94%), with elevated direct bilirubin, GGT, and ALT being most common.
- Low albumin, high direct bilirubin, and high total bilirubin were identified as independent risk factors for mortality. Left ventricular ejection fraction and right ventricular end-diastolic diameter showed correlations with liver function markers.
Impact:
- Highlights the high prevalence of liver dysfunction in chronic systolic HF patients.
- Identifies specific liver function markers (low albumin, high direct/total bilirubin) as significant predictors of mortality.
- Provides evidence for the association between cardiac dysfunction and liver abnormalities, informing clinical management and risk stratification.
Objective:
To evaluate systemically the prevalence and prognostic values of liver function abnormalities in patients with chronic systolic heart failure (HF) have not been systematically evaluated.
Methods:
A total of 16 681 hospitalized patients with a diagnosis of chronic systolic HF and left ventricular ejection fraction (LVEF) < 50% were recruited from 12 hospitals in Hubei Province. All patients were followed up by telephone contacts. And they were divided into the death and survival groups according to the follow-up results.
Results:
Over a median follow-up period of 3 years, 6453 (38.69%) patients died. The prevalence of liver function abnormality was 71.94% (12 001/16 681). The elevations of direct bilirubin, γ-glutamyl-transferase and alanine aminotransferase were the most common findings accounting for 33.37% (4863/14 574), 32.51% (4337/13 341) and 30.12% (5024/16 681) respectively. The abnormality of alkaline phosphatase was rare and its increase and decrease accounted for 3.82% (474/12 397) and 4.51% (559/12 397) respectively. The prevalence of low albumin and total bilirubin elevation was 23.24% (3408/14 664) and 19.37% (3231/16 681). And high direct bilirubin (HR 1.264, 95%CI 1.103 - 1.423; P = 0.02), high total bilirubin (HR 1.126, 95%CI 1.019 - 1.234; P = 0.02) and low albumin (HR 0.889, 95%CI 0.794 - 0.889; P < 0.01) were determined as the independent risk factors of total mortality. There were the correlations of LVEF with direct bilirubin (r = -0.235, P < 0.01), total bilirubin (r = -0.209, P < 0.01), albumin (r = 0.107, P < 0.01) and right ventricular end-diastolic diameter (RVDD) with direct bilirubin (r = 0.149, P < 0.01), total bilirubin (r = 0.154, P < 0.01) and albumin (r = -0.086, P < 0.01).
Conclusion:
The prevalence of liver function abnormalities is high in patients with chronic systolic HF. Low albumin, high direct bilirubin and high total bilirubin increase their total mortalities. Low LVEF and high RVDD are positively correlated with a high prevalence of liver function abnormalities.
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