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. 2009 Feb;11(2):170-7.
doi: 10.1093/eurjhf/hfn031.

Liver function abnormalities and outcome in patients with chronic heart failure: data from the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) program

Larry A Allen  1 , G Michael Felker, Stuart Pocock, John J V McMurray, Marc A Pfeffer, Karl Swedberg, Duolao Wang, Salim Yusuf, Eric L Michelson, Christopher B Granger; CHARM Investigators
Affiliations

Liver function abnormalities and outcome in patients with chronic heart failure: data from the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) program

Larry A Allen et al. Eur J Heart Fail. 2009 Feb.

Abstract

Aims: The prevalence and importance of liver function test (LFT) abnormalities in a large contemporary cohort of heart failure patients have not been systematically evaluated.

Methods and results: We characterized the LFTs of 2679 patients with symptomatic chronic heart failure from the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity program (CHARM). We used multivariable modelling to assess the relationships between baseline LFT values and long-term outcomes. Liver function test abnormalities were common in patients with chronic heart failure, ranging from alanine aminotransferase elevation in 3.1% of patients to low albumin in 18.3% of patients; total bilirubin was elevated in 13.0% of patients. In multivariable analysis, elevated total bilirubin was the strongest LFT predictor of adverse outcome for both the composite outcome of cardiovascular death or heart failure hospitalization (HR 1.21 per 1 SD increase, P<0.0001) and all-cause mortality (HR 1.19 per 1 SD increase, P<0.0001). Even after adjustment for other variables, elevated total bilirubin was one of the strongest independent predictors of poor prognosis (by global chi-square).

Conclusion: Bilirubin is independently associated with morbidity and mortality. Changes in total bilirubin may offer insight into the underlying pathophysiology of chronic heart failure.

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Figures

Figure 1
Figure 1
Prevalence of baseline liver function test abnormalities stratified by occurrence of cardiovasular death or heart failure hospitalization during follow-up. Legend: ↑Total bili, total bilirubin above upper limit of normal; ↑ALT, alanine transaminase above upper limit of normal; ↑Alk Phos, alkaline phosphatase above upper limit of normal; ↓Albumin, albumin below lower limit of normal; *primary study outcome was CV death or HF hospitalization at a mean follow up of 3.1 years.
Figure 2
Figure 2
Adjusted hazard ratios by quintile of total bilirubin for (A) cardiovascular death or heart failure hospitalization and (B) all-cause mortality in CHARM.
See this image and copyright information in PMC

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