LIVER INJURY MARKERS IN DECOMPENSATED HEART FAILURE: PHENOTYPES, CLINICAL AND PROGNOSTIC VALUE

Abstract

Aim: The aim of this study was to assess the incidence, clinical and instrumental associations and prognostic value of cardiohepatic syndrome (CHS) phenotypes CHS in decompensated heart failure (DHF). Methods: CHS was diagnosed in 322 patients with DHF (190 male, 70±11 years (M±SD), arterial hypertension 87%, myocardial infarction 57%, atrial fibrillation 65%, type 2 diabetes mellitus 42%, left ventricular ejection fraction (EF) 38±13%, EF<40% 50%, NYHA IV 56%) when at least one liver function test (LFT) level exceeded upper normal limit on admission. Only alanine transaminase (ALT) and/or aspartate transaminase (AST) increase was considered as hepatocellular CHS, isolated increase of gamma-glutamyl transpeptidase (GGT), alkaline phosphatase (AP), direct bilirubin (DB) and total bilirubin (TB) due DB increase - as cholestatic CHS, the simultaneous increase of markers of cytolysis and cholestasis - as mixed CHS. Mann-Whitney U, Kruskal-Wallis and Pearson’s chi-square tests were used. P <0.05 was considered significant for paired comparison, <0,017 - for comparison of 3 groups. Results: CHS occurs in 85,1% patients, predominantly mixed (66,8%) and moderate (LFT increase ≤ 3UNL). Patients with mixed vs cholestatic CHS had higher levels of LFT, incidence of cholestatic markers increase, NT-proBNP level, hypoperfusion (high heart rate, lower systolic blood pressure (BP) and pulse BP on admission), higher rate of incidence of EF<35% and vasopressor therapy. No significant differences in signs of congestion were observed between groups. Mixed CHS was associated with higher all-cause death in 6 months (30 vs 23%, p<0.05). Conclusions: Mixed CHS predominates in patients with DHF and is associated with more pronounced LFT increase, higher NT-proBNP levels, hypoperfusion (lower systolic and pulse BP, EF <35%, use of vasopressors and inotropes, worse prognosis.