Abnormal transaminases in acute decompensated heart failure were associated with greater 180-day mortality compared with normal transaminase profiles (31.6% vs. 22.4%, P<0.001).
Observational (n=1,134)
Yes
Are abnormal liver function tests associated with increased mortality in patients with acute decompensated heart failure?
In patients with acute decompensated heart failure treated with inotropes, abnormal transaminases are associated with increased short- and long-term mortality, while abnormal alkaline phosphatase is associated with increased long-term mortality.
Absolute Event Rate: 31.6% vs 22.4%
p-value: p=<0.001
AIMS: The aim of this study was to assess the prevalence of abnormal liver function tests (LFTs) and the associated clinical profile and outcome(s) in acute decompensated heart failure (ADHF) patients. Alteration in LFTs is a recognized feature of ADHF, but prevalence and outcomes data from a broad contemporary cohort of ADHF are scarce and the mechanism(s) of ADHF-induced cholestasis is unknown. METHODS AND RESULTS: We conducted a post hoc analysis of SURVIVE, a large clinical trial including ADHF patients treated with levosimendan or dobutamine. All LFTs were available in 1134 patients at baseline. Abnormal LFTs were seen in 46% of ADHF patients: isolated abnormal alkaline phosphatase (AP) was noted in 11%, isolated abnormal transaminases in 26%, and a combination of abnormal AP and transaminases in 9%. Abnormal AP was associated with marked signs of systemic congestion and elevated right-sided filling pressure. Abnormal AP had no relationship with 31-day mortality but was associated with worse 180-day mortality (23.5 vs. 34.9%, P = 0.001 vs. patients with normal AP). Abnormal transaminases were associated with clinical signs of hypoperfusion and with greater 31-day and 180-day mortality compared with normal transaminase profiles (17.6 vs. 8.4% and 31.6 vs. 22.4%, respectively; both P < 0.001). There was no additive value of abnormal AP plus abnormal transaminase on a long-term outcome. CONCLUSION: Abnormal LFTs were present in about a half of patients presenting with ADHF treated with inotropes. Abnormal AP and abnormal transaminases were associated with specific clinical, biological, and prognostic features, including a short-term overmortality with increased transaminases but not with biological signs of cholestasis, in ADHF patients.
Nikolaou et al. (Mon,) conducted a observational in Acute decompensated heart failure (ADHF) (n=1,134). Abnormal transaminases vs. Normal transaminases was evaluated on 180-day mortality (p=<0.001). Abnormal transaminases in acute decompensated heart failure were associated with greater 180-day mortality compared with normal transaminase profiles (31.6% vs. 22.4%, P<0.001).