Liver function, in-hospital, and post-discharge clinical outcome in patients with acute heart failure-results from the relaxin for the treatment of patients with acute heart failure study.

Abstract

BACKGROUND:

Elevated plasma concentrations of liver function tests are prevalent in patients with chronic heart failure (HF). Little is known about liver function in patients with acute HF. We aimed to assess the prevalence and prognostic value of serial measurements of liver function tests in patients admitted with acute decompensated HF.

METHODS:

We investigated liver function tests from all 234 patients from the Relaxin for the Treatment of Patients With Acute Heart Failure study at baseline and during hospitalization. The end points were worsening HF through day 5, 60-day mortality or rehospitalization, and 180-day mortality.

RESULTS:

Mean age was 70 ± 10 years, 56% were male, and most patients were in New York Heart Association functional class III/IV (73%). Abnormal liver function tests were frequently found for alanine transaminase (ALT; 12%), aspartate transaminase (AST; 21%), alkaline phosphatase (12%), and total bilirubin (19%), and serum albumin (25%) and total protein (9%) were decreased. In-hospital changes were very small. On a continuous scale, baseline ALT and AST were associated with 180-day mortality (hazard ratios [HRs; per doubling] 1.52 [P = .030] and 1.97 [P = .013], respectively) and worsening HF through day 5 (HRs [per doubling] 1.72 [P = .005] and 1.95 [P = .008], respectively). Albumin was associated with 180-day mortality (HR 0.86; P = .001) but not with worsening HF (HR 0.95; P = .248). Total protein was associated with only worsening HF (HR 0.91; P = .004).

CONCLUSIONS:

Abnormal liver function tests are often present in patients with acute HF and are associated with an increased risk for mortality, rehospitalization, and in-hospital worsening HF.

• Authors: Vincent M van Deursen, Christopher Edwards, Gad Cotter, Beth A Davison, Kevin Damman, John R Teerlink, Marco Metra, G Michael Felker, Piotr Ponikowski, Elaine Unemori, Thomas Severin, Adriaan A Voors
• Journal: Journal of cardiac failure (J Card Fail) Vol. 20 Issue 6 Pg. 407-13 (Jun 2014) ISSN: 1532-8414 [Electronic] United States
• PMID: 24642379 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 Elsevier Inc. All rights reserved.

Chemical References

• Relaxin

Topics

• Acute Disease
• Aged
• Aged, 80 and over
• Female
• Follow-Up Studies
• Heart Failure (blood, drug therapy, mortality)
• Hospitalization (trends)
• Humans
• Liver (physiology)
• Liver Function Tests (mortality, trends)
• Male
• Middle Aged
• Patient Discharge (trends)
• Relaxin (therapeutic use)
• Survival Rate (trends)
• Treatment Outcome