[PP.14.15] PROGNOSTIC VALUE OF DIFFERENT LIVER FUNCTION TESTS PATTERNS IN ACUTE DECOMPENSATED HEART FAILURE

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Abstract

Objective:

Over the last several years different mechanisms of cardiohepatic syndrome(CHS) in acute decompensated heart failure(ADHF) have been discussed. Hepatocellular liver function tests pattern predominated in left sided forward AHF, cholestatic pattern occurred mainly in bilateral and right sided AHF. The aim of the study was to assess the prevalence and prognostic value of different patterns of CHS in ADHF.

Design and method:

In 322 patients with ADHF(190 male,69.5 ± 10.7 years(M ± SD), arterial hypertension 87%, myocardial infarction 56.5%, atrial fibrillation 65.5%, diabetes mellitus 41.6%, chronic kidney disease 39.1%, chronic anemia 29.2%, ejection fraction(EF) 37.6 ± 12.6%, EF < 35% 39.1%) alanine transaminase(ALT), aspartate transaminase(AST), alkaline phosphatase(AP) and gamma-glutamyl transpeptidase(GGT) were measured on admission. LFTs were considered abnormal when levels exceeded local upper normal limit. Only ALT and/or AST increase was considered as hepatocellular CHS, only GGT and/or AP increase – as cholestatic CHS. The simultaneous increase of markers of cytolysis and cholestasis was considered as mixed CHS.Mann-Whitney test and multivariate logistic regression analysis were performed, p < 0.05 was considered statistically significant.

Results:

Abnormal LFTs occurred in 166(51.6%) of patients. Increase of ALT and/or AST were detected in 68(21.1%) patients (alone ALT/alone AST/both TA – in 35.3/26.5/38.2% respectively), increase of AP and/or GGT in 140 (43.4%) patients (alone AP/alone GGT/both of them – in 27.15/35.7/37.15% respectively). Hepatocellular, cholestatic and mixed pattern of CHS was detected in 8.1, 30.4 and 13.1% of patients with ADHF. In patients with CHS the prevalence of hepatocellular, cholestatic and mixed pattern was 15.7,59,25.3% respectively. Patients with mixed CHS comparing with hepatocellular or cholestatic patterns had lower BMI(28.4 ± 5.3 vs 30.2 ± 7.6 or 31.4 ± 5.6 kg/m2, p < 0.05), total protein (64 ± 4.8 vs 64.7 ± 6.7 or 68.9 ± 7.3 g/l, p < 0.01), eGFR(47 ± 17 vs 57 ± 17 or 56 ± 20 ml/min/1.73 m2,p < 0.01), higher heart rate(118 ± 35 vs 91 ± 17 or 101 ± 30 per min, p < 0.01), Hb(137 ± 20 vs 120 ± 22 or 129 ± 24 g/l, p < 0.05), serum creatinine(146 ± 71 vs 117 ± 39 or 117 ± 34 μmol/l, p < 0.001). Only mixed CHS was associated with negative prognosis. In patients with versus without mixed CHS the incidence of all-cause death in 6 months was 24.2 vs 12.1%, p < 0,05.

Conclusions:

Abnormal LFTs occurred in 51.6% of patients with ADHF. The prevalence of hepatocellular, cholestatic and mixed pattern was 15.7, 59, 25.3%. Patients with mixed compared with hepatocellular or cholestatic pattern of CHS had a worse prognosis.

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