Association Between Liver Dysfunction Markers and Mortality in Heart Failure: A Systematic Review and Meta-Analysis

Heart failure (HF) is a major cause of morbidity and mortality worldwide and is frequently associated with dysfunction of other organs, including the liver. Hepatic congestion and impaired perfusion from cardiac dysfunction may lead to liver injury, described as cardiohepatic syndrome. Studies suggest that liver dysfunction markers, such as the Model for End-Stage Liver Disease (MELD) and MELD excluding international normalized ratio (MELD-XI) scores, may serve as prognostic indicators in HF patients. This systematic review and meta-analysis evaluated the relationship between liver dysfunction markers and mortality outcomes in HF patients. A systematic literature search was conducted. Studies evaluating the association between liver dysfunction markers (MELD or MELD-XI scores) and mortality outcomes in adult HF patients were included. Hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled using the generic inverse variance method with a random-effects model in Review Manager (RevMan) version 5.4 (The Cochrane Collaboration, Copenhagen, Denmark). Subgroup analyses were performed by liver dysfunction marker type and HF phenotype. The primary outcome was all-cause mortality. Nine studies comprising over 32,000 HF patients were included. Elevated liver dysfunction markers were significantly associated with increased mortality risk (pooled HR = 1.12, 95% CI 1.06-1.18). Substantial heterogeneity was observed (I² = 91%). Subgroup analysis showed significant associations for both MELD-XI (HR = 1.09, 95% CI 1.04-1.14) and MELD scores (HR = 1.10, 95% CI 1.06-1.14). Analysis by HF type revealed significant associations in acute HF (HR = 1.07), chronic HF (HR = 1.23), and advanced HF (HR = 1.05). Sensitivity analyses confirmed the findings, with no substantial publication bias observed. Elevated liver dysfunction markers significantly correlate with increased mortality in HF patients. Both MELD and MELD-XI scores provide prognostic information across HF populations. These findings emphasize the importance of considering hepatic dysfunction in HF assessment and suggest liver dysfunction markers may aid risk stratification. Further prospective studies are needed to determine the role of these markers in clinical decision-making.