Background:
Hepatic congestion leading to abnormal liver function tests (LFTs) is a common finding in patients with acute decompensated heart failure. The aim of this study was to determine the prognostic significance, if any, of abnormal LFTs in acute decompensated heart failure, as this has not been extensively studied so far.
Methods:
A retrospective chart review of all adult patients (>18 years old) who were admitted to a community hospital with a diagnosis of acute decompensated heart failure during the period from January 1, 2008, to June 30, 2010, was performed. Of the 187 patients identified, 170 patients were included in the study. Exclusion criteria included insufficient laboratory data, acute/chronic kidney injury (serum creatinine > 2 mg/dL), acute myocardial infarction, hepatitis (drug‐induced/infectious), malignancy, and death from any cause other than heart failure. Primary end points of the study were readmission or death secondary to heart failure. The Cox proportional hazard model was used for statistical analysis of the data. P ≤ 0.05 was considered statistically significant.
Results:
The mean age of the patients was 78.5 years. Forty‐two percent of the patients were men. One hundred and twenty‐two patients were readmitted secondary to heart failure during the study period. Serum total bilirubin (P < 0.01), serum B‐natriuretic peptide (P < 0.05), ejection fraction (P < 0.05), and heart rate (P < 0.05) were found to be significant predictors of hospital readmission secondary to acute decompensated heart failure. Multivariate analysis showed that high serum total bilirubin (>1.3 mg/dL) on admission was an independent predictor (P = 0.05) of hospital readmission secondary to heart failure. Blood pressure (systolic/diastolic), serum creatinine, serum sodium, serum alkaline phosphatase, serum alanine transaminase, and serum aspartate transaminase levels on admission were not significant predictors of readmission secondary to heart failure. An analysis by stratification showed that patients with serum total bilirubin >1.3 mg/dL on admission had a readmission rate that was 78% ± 20% higher (P < 0.01) at any given time than those with serum total bilirubin ≤ 1.3 mg/dL. Patients with either serum total bilirubin > 1.3 mg/dL on admission or an ejection fraction < 35% collectively had a readmission rate that was 87% ± 20% higher (P < 0.05) than those without these criteria.
Conclusions:
In patients with acute decompensated heart failure, elevated serum total bilirubin on admission with or without low ejection fraction (<35%) predicts worse prognosis and early future readmission secondary to heart failure.
Disclosures:
J. Chintanaboina ‐ none; M. Haner ‐ none; A. Sethi ‐ none; N. Patel ‐ none; W. Tanyous ‐ none; A. Lalos ‐ none