Serum bilirubin as a prognostic marker in patients with acute decompensated heart failure

Abstract

Background/aims: Several prognostic markers for heart failure (HF) have been determined but the importance of liver function tests (LFTs) remains unknown. The aim of this study was to determine the prognostic significance, if any, of abnormal LFTs in acute decompensated HF.

Methods: All adult patients (> 18 years of age) who were admitted to a community hospital with a diagnosis of acute decompensated HF during the period January 2008 to December 2009 were identified. Exclusion criteria included acute coronary syndrome, active hepatobiliary disease, renal failure (serum creatinine ≥ 2 mg/dL), and malignancy. The primary end point was readmission secondary to acute exacerbation of HF. The Cox proportional hazard model was used for statistical analyses.

Results: Univariate analysis showed that serum total bilirubin (TB, p < 0.01), serum B-type natriuretic peptide (p < 0.05), ejection fraction (EF, p < 0.05), and heart rate (p < 0.05) were significant predictors of hospital readmission secondary to acute decompensated HF. Multivariate analysis showed that high serum TB (> 1.3 mg/dL) on admission was an independent predictor (p < 0.05) of hospital readmission secondary to HF. The 'at-risk' group-patients with serum TB > 1.3 mg/dL and/or EF < 35% on admission-had a readmission rate that was 87% ± 20% (p < 0.05) higher than those with neither criterion.

Conclusions: In patients with acute decompensated HF, elevated serum TB on admission with or without low EF (< 35%) predicts a worse prognosis and early future readmission, secondary to HF.

Keywords: Bilirubin; Heart failure; Liver; Prognosis.

Figure 1

The Kaplan-Meier survival curves show significant differences in heart failure readmissions between the groups. Upper curve, of the 121 patients with serum total bilirubin (TB) ≤ 1.3 mg/dL, 80 were readmitted within the study period. Lower curve, of the 31 patients with TB > 1.3 mg/dL, 29 were readmitted during the study period.

Figure 2

The Kaplan-Meier survival curves show significant differences in heart failure readmissions between the groups. Upper curve, of the 70 patients with serum total bilirubin (TB) ≤ 1.3 mg/dL and ejection fraction (EF) ≥ 35%, 39 were readmitted during the study period. Lower curve, of the 74 patients with serum TB > 1.3 mg/dL and/or an EF < 35% on admission, 64 were readmitted during the study period.