Elevated levels of vitamin B12 in chronic stable heart failure: a marker for subclinical liver damage and impaired prognosis
| Autor: | Guliz Kozdag, Ayşen Ağaçdiken Ağır, Serdar Bozyel, Onur Argan, Mujdat Aktas, Kurtulus Karauzum, Dilek Ural, Irem Karauzum |
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| Přispěvatelé: | Zonguldak Bülent Ecevit Üniversitesi, Ural, Dilek, Argan, Onur, Karaüzüm, Kurtuluş, Bozyel, Serdar, Aktaş, Müjdat, Karaüzüm, İrem Yılmaz, Kozdağ, Güliz, Ağır, Ayşen Agaçdiken, School of Medicine, Department of Cardiology |
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
Therapeutics and Clinical Risk Management Bilirubin Renal function heart failure 030204 cardiovascular system & hematology Gastroenterology Medicine Health care sciences and services 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Internal medicine 0502 economics and business medicine Pharmacology (medical) Vitamin B12 General Pharmacology Toxicology and Pharmaceutics Univariate analysis Chemical Health and Safety Ejection fraction business.industry Proportional hazards model 05 social sciences Heart failure Prognosis Area under the curve General Medicine vitamin B12 medicine.disease chemistry 050211 marketing prognosis bilirubin business Safety Research |
| Zdroj: | Therapeutics and Clinical Risk Management |
| ISSN: | 1178-203X 0004-3435 |
| Popis: | WOS: 000434357200002 PubMed: 29922067 Background: Elevated vitamin B12 is a sign for liver damage, but its significance in chronic stable heart failure (HF) is less known. The present study investigated the clinical correlates and prognostic significance of vitamin B12 levels in stable systolic HF. Methods: A total of 129 consecutive patients with HF and 50 control subjects were enrolled. Data regarding demographics, clinical signs, therapeutic and conventional echocardiographic measurements were recorded for all patients. Right-sided HF was defined as the presence of at least one of the typical symptoms (ankle swelling) or specific signs (jugular venous distention or abdominojugular reflux) of right HF. Cox proportional hazards regression analyses were performed to determine the independent prognostic determinants of mortality. Results: Baseline B12 levels in HF patients (n=129) with and without right sided HF were significantly higher compared to healthy controls (n=50): Median 311 pg/mL and 235 pg/mL vs 198 pg/mL, respectively (P=0.005). Folic acid levels were similar between the study groups. Age, ejection fraction, left atrial size, estimated glomerular filtration rate, and direct and indirect bilirubin levels were significantly correlated to serum B12 level in univariate analysis. In multivariate analysis, independent correlates of B12 were direct bilirubin (R=0.51, P= 270 pg/mL had 80% sensitivity and 58% specificity for predicting all-cause mortality (area under the curve=0.672, 95% CI=0.562-0.781; P=0.003). However, in Cox regression analysis, only left atrial diameter, level of direct bilirubin, and the presence of abdominojugular reflux were independent predictors of death. Conclusion: Increased B12 in stable HF patients is associated with increased direct bilirubin due to right HF, indicating a cardiohepatic syndrome, but neither B12 nor folic acid are independently associated with mortality. |
| Databáze: | OpenAIRE |
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