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Abnormal liver function tests in acute heart failure: relationship with clinical characteristics and outcome in the PROTECT study.

Publication ,  Journal Article
Biegus, J; Hillege, HL; Postmus, D; Valente, MAE; Bloomfield, DM; Cleland, JGF; Cotter, G; Davison, BA; Dittrich, HC; Fiuzat, M; Givertz, MM ...
Published in: Eur J Heart Fail
July 2016

AIMS: Episodes of acute heart failure (AHF) unfavourably affect multiple organs, which may have an adverse impact on the outcomes. We investigated the prevalence and clinical consequences of abnormal liver function tests (LFTs) in AHF patients enrolled in the PROTECT study. METHODS AND RESULTS: The LFTs comprised serial assessment of aspartate aminotransferase (AST), alanine aminotransferase (ALT) and albumin at baseline and during follow-up (daily until discharge, on days 7 and 14). The prevalence of abnormal LFTs (above upper limit of normal for AST and ALT or below lower limit of normal for albumin) was: at baseline AST 20%, ALT 12%, albumin 40%; and at day 14: AST 15%, ALT 9%, albumin 26%. Abnormal LFTs at baseline were associated with a higher risk of in-hospital death with odds ratios [95% confidence interval (CI)] of 3.5 (1.7-7.3) for AST, 3.9 (1.8-8.4) for ALT, and 2.8 (1.3-5.9) for albumin (all P < 0.01). Abnormal baseline and discharge LFTs had an unfavourable impact on 180-day mortality with hazard ratios (95% CI) for baseline AST, ALT, and albumin of 1.3 (1.0-1.7), 1.1 (1.0-1.2), 1.4 (1.1-1.8), respectively, and 1.5 (1.1-2.0), 1.5 (1.0-2.2), and 1.6 (1.2-2.1), for discharge AST, ALT, albumin, respectively (all P < 0.05). Analysis of LFTs trajectories (calculated as changes in LFTs over time) revealed that increasing AST and ALT on day 3 as well as decreasing albumin on day 4 were independent prognosticators of 180-day outcome (all P < 0.05). CONCLUSIONS: Abnormal LFTs are frequent in AHF at baseline and during hospital stay and predict worse outcomes. Whether this association is causal and what are the underlying mechanisms involved require further study.

Duke Scholars

Published In

Eur J Heart Fail

DOI

EISSN

1879-0844

Publication Date

July 2016

Volume

18

Issue

7

Start / End Page

830 / 839

Location

England

Related Subject Headings

  • Xanthines
  • Serum Albumin
  • Renal Insufficiency, Chronic
  • Randomized Controlled Trials as Topic
  • Proportional Hazards Models
  • Prognosis
  • Middle Aged
  • Male
  • Liver Function Tests
  • Humans
 

Citation

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Biegus, J., Hillege, H. L., Postmus, D., Valente, M. A. E., Bloomfield, D. M., Cleland, J. G. F., … Ponikowski, P. (2016). Abnormal liver function tests in acute heart failure: relationship with clinical characteristics and outcome in the PROTECT study. Eur J Heart Fail, 18(7), 830–839. https://doi.org/10.1002/ejhf.532
Biegus, Jan, Hans L. Hillege, Douwe Postmus, Mattia A. E. Valente, Daniel M. Bloomfield, John G. F. Cleland, Gad Cotter, et al. “Abnormal liver function tests in acute heart failure: relationship with clinical characteristics and outcome in the PROTECT study.Eur J Heart Fail 18, no. 7 (July 2016): 830–39. https://doi.org/10.1002/ejhf.532.
Biegus J, Hillege HL, Postmus D, Valente MAE, Bloomfield DM, Cleland JGF, et al. Abnormal liver function tests in acute heart failure: relationship with clinical characteristics and outcome in the PROTECT study. Eur J Heart Fail. 2016 Jul;18(7):830–9.
Biegus, Jan, et al. “Abnormal liver function tests in acute heart failure: relationship with clinical characteristics and outcome in the PROTECT study.Eur J Heart Fail, vol. 18, no. 7, July 2016, pp. 830–39. Pubmed, doi:10.1002/ejhf.532.
Biegus J, Hillege HL, Postmus D, Valente MAE, Bloomfield DM, Cleland JGF, Cotter G, Davison BA, Dittrich HC, Fiuzat M, Givertz MM, Massie BM, Metra M, Teerlink JR, Voors AA, O’Connor CM, Ponikowski P. Abnormal liver function tests in acute heart failure: relationship with clinical characteristics and outcome in the PROTECT study. Eur J Heart Fail. 2016 Jul;18(7):830–839.
Journal cover image

Published In

Eur J Heart Fail

DOI

EISSN

1879-0844

Publication Date

July 2016

Volume

18

Issue

7

Start / End Page

830 / 839

Location

England

Related Subject Headings

  • Xanthines
  • Serum Albumin
  • Renal Insufficiency, Chronic
  • Randomized Controlled Trials as Topic
  • Proportional Hazards Models
  • Prognosis
  • Middle Aged
  • Male
  • Liver Function Tests
  • Humans