Evidence of Mild Liver Dysfunction Identifies Stable Heart Failure Outpatients with Reversible Renal Dysfunction.
Pubmed ID: 26195975
Pubmed Central ID: PMC4478303
Journal: Cardiorenal medicine
Publication Date: 06/01/2015
Affiliation: Program of Applied Translational Research, Yale University School of Medicine, New Haven, Conn., USA ; Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn., USA.
Grants: K23 HL114868
Authors: Testani JM, Brisco MA, Laur O, Kula AJ, Cheng SJ
Cite As: Brisco MA, Cheng SJ, Laur O, Kula AJ, Testani JM. Evidence of Mild Liver Dysfunction Identifies Stable Heart Failure Outpatients with Reversible Renal Dysfunction. Cardiorenal Med 2015 Jun;5(3):229-36. Epub 2015 Jun 6.
BACKGROUND: In decompensated heart failure (HF), reversible renal dysfunction (RD) is more frequently observed in patients with mild liver dysfunction likely due to the shared pathophysiologic factors involved. The objective of this study was to determine if these findings also apply to stable HF outpatients. METHODS: Patients in the Beta-Blocker Evaluation of Survival Trial (BEST) were studied. Improvement in renal function (IRF) was defined as a 20% improvement in the estimated glomerular filtration rate from baseline to 3 months. RESULTS: Elevated bilirubin (BIL), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were significantly associated with signs of congestion or poor perfusion. IRF occurred in 12.0% of all patients and was more common in those with elevated BIL (OR = 1.5, p = 0.003), ALT (OR = 1.4, p = 0.01), and AST (OR = 1.4, p = 0.01). In a model containing all 3 liver parameters and baseline characteristics, including markers of congestion/poor perfusion, BIL (OR = 1.6, p = 0.001) and ALT (OR = 1.7, p < 0.001) were independently associated with IRF. CONCLUSIONS: Biochemical evidence of mild liver dysfunction is significantly associated with IRF in stable HF outpatients. Given the widespread availability and low cost of these markers, additional research is necessary to determine the utility of these parameters in identifying patients with reversible RD who may benefit from cardiorenal interventions.