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Association between bilirubin and mode of death in severe systolic heart failure.

Publication ,  Journal Article
Wu, AH; Levy, WC; Welch, KB; Neuberg, GW; O'Connor, CM; Carson, PE; Miller, AB; Ghali, JK
Published in: Am J Cardiol
April 15, 2013

The bilirubin level has been associated with worse outcomes, but it has not been studied as a predictor for the mode of death in patients with systolic heart failure. The Prospective Randomized Amlodipine Evaluation Study (PRAISE) cohort (including New York Heart Association class IIIB-IV patients with left ventricular ejection fraction <30%, n = 1,135) was analyzed, divided by bilirubin level: ≤0.6 mg/dl, group 1; >0.6 to 1.2 mg/dl, group 2; and >1.2 mg/dl, group 3. Multivariate Cox proportional hazards models were used to determine the association of bilirubin with the risk of sudden or pump failure death. Total bilirubin was entered as a base 2 log-transformed variable (log2 bilirubin), indicating doubling of the bilirubin level corresponding to each increase in variable value. The higher bilirubin groups had a lower ejection fraction (range 19% to 21%), sodium (range 138 to 139 mmol/L), and systolic blood pressure (range 111 to 120 mm Hg), a greater heart rate (range 79 to 81 beats/min), and greater diuretic dosages (range 86 to 110 furosemide-equivalent total daily dose in mg). The overall survival rates declined with increasing bilirubin (24.3, 31.3, and 44.3 deaths per 100 person-years, respectively, for groups 1, 2, and 3). Although a positive relation was seen between log2 bilirubin and both pump failure risk and sudden death risk, the relation in multivariate modeling was significant only for pump failure mortality (hazard ratio 1.47, 95% confidence interval 1.19 to 1.82, p = 0.0004), not for sudden death mortality (hazard ratio 1.21, 95% confidence interval 0.98 to 1.49, p = 0.08). In conclusion, an increasing bilirubin level was significantly associated with the risk of pump failure death but not for sudden death in patients with severe systolic heart failure.

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Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

April 15, 2013

Volume

111

Issue

8

Start / End Page

1192 / 1197

Location

United States

Related Subject Headings

  • Survival Rate
  • Prospective Studies
  • Proportional Hazards Models
  • Predictive Value of Tests
  • Middle Aged
  • Male
  • Humans
  • Heart Failure, Systolic
  • Female
  • Death, Sudden, Cardiac
 

Citation

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Wu, A. H., Levy, W. C., Welch, K. B., Neuberg, G. W., O’Connor, C. M., Carson, P. E., … Ghali, J. K. (2013). Association between bilirubin and mode of death in severe systolic heart failure. Am J Cardiol, 111(8), 1192–1197. https://doi.org/10.1016/j.amjcard.2012.12.048
Wu, Audrey H., Wayne C. Levy, Kathleen B. Welch, Gerald W. Neuberg, Christopher M. O’Connor, Peter E. Carson, Alan B. Miller, and Jalal K. Ghali. “Association between bilirubin and mode of death in severe systolic heart failure.Am J Cardiol 111, no. 8 (April 15, 2013): 1192–97. https://doi.org/10.1016/j.amjcard.2012.12.048.
Wu AH, Levy WC, Welch KB, Neuberg GW, O’Connor CM, Carson PE, et al. Association between bilirubin and mode of death in severe systolic heart failure. Am J Cardiol. 2013 Apr 15;111(8):1192–7.
Wu, Audrey H., et al. “Association between bilirubin and mode of death in severe systolic heart failure.Am J Cardiol, vol. 111, no. 8, Apr. 2013, pp. 1192–97. Pubmed, doi:10.1016/j.amjcard.2012.12.048.
Wu AH, Levy WC, Welch KB, Neuberg GW, O’Connor CM, Carson PE, Miller AB, Ghali JK. Association between bilirubin and mode of death in severe systolic heart failure. Am J Cardiol. 2013 Apr 15;111(8):1192–1197.
Journal cover image

Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

April 15, 2013

Volume

111

Issue

8

Start / End Page

1192 / 1197

Location

United States

Related Subject Headings

  • Survival Rate
  • Prospective Studies
  • Proportional Hazards Models
  • Predictive Value of Tests
  • Middle Aged
  • Male
  • Humans
  • Heart Failure, Systolic
  • Female
  • Death, Sudden, Cardiac