Usefulness of the Direct and/or Total Bilirubin to Predict Adverse Outcomes in Patients With Acute Decompensated Heart Failure
| Autor: | Atsushi Okada, Yasuo Sugano, Toshiyuki Nagai, Yasuyuki Honda, Naotsugu Iwakami, Hiroki Nakano, Seiji Takashio, Satoshi Honda, Yasuhide Asaumi, Takeshi Aiba, Teruo Noguchi, Kengo Kusano, Satoshi Yasuda, Toshihisa Anzai, Shoji Kawakami, Yoshiya Yamamoto, Masahiro Yamamoto, Tetsufumi Motokawa, Yasuhiro Hamatani, Tatsuhiro Shibata, Takehiro Homma, Daigo Chinen, Takafumi Yamane, Chinatsu Yoshida, Sachiko Ogura, Akiko Maruta, Yoko Sumita |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Acute decompensated heart failure Kaplan-Meier Estimate 030204 cardiovascular system & hematology Patient Readmission Severity of Illness Index Inferior vena cava 03 medical and health sciences 0302 clinical medicine Japan Liver Function Tests Cause of Death Internal medicine medicine Humans Prospective Studies 030212 general & internal medicine Aged Aged 80 and over Heart Failure Ejection fraction medicine.diagnostic_test business.industry Hazard ratio Bilirubin Stroke Volume Middle Aged Prognosis medicine.disease Confidence interval Pulse pressure Survival Rate medicine.vein Heart failure Acute Disease Cardiology Female Cardiology and Cardiovascular Medicine business Liver function tests Biomarkers |
| Zdroj: | The American Journal of Cardiology. 119:2035-2041 |
| ISSN: | 0002-9149 |
| Popis: | Abnormal liver function test results are often observed in acute decompensated heart failure (ADHF). However, the prognostic value of bilirubin fractionation has not been elucidated. The prognostic value of direct bilirubin (DB), in comparison with total bilirubin (TB), was examined in 556 consecutive patients with ADHF. Patients with elevated DB showed mostly similar patient characteristics including signs of elevated right-sided pressure (frequent hepatomegaly, jugular venous distention, dilated inferior vena cava, and elevated gamma-glutamyltransferase) and decreased cardiac output (cold extremities, decreased pulse pressure, and lower blood pressure) and other parameters of heart failure (HF) severity (increased plasma renin activity, decreased sodium, total cholesterol, and ejection fraction) to elevated TB; however, only patients with elevated DB showed a significant difference in the frequency of HF history and alkaline phosphatase value. Kaplan-Meier analysis showed that patients with elevated DB had a significantly higher rate of the composite end point of all-cause mortality or HF readmission (p = 0.021) compared with those with normal DB, whereas patients with elevated TB did not show a statistically significant difference compared with those with normal TB (NS). A multivariate Cox hazards model showed that DB was an independent predictor of adverse events (adjusted hazard ratio 1.052, 95% confidence interval 1.001 to 1.099, p = 0.034), whereas TB was not (adjusted hazard ratio 1.017, 95% confidence interval 0.985 to 1.046, p = 0.27). Adding DB to existing prognostic variables resulted in higher C-statistics than adding TB (C-statistics: 0.670 to 0.675, 0.670 to 0.674, respectively). In conclusion, elevated DB in ADHF was an independent prognostic predictor that was superior to TB. DB may be useful for further risk stratification in ADHF. |
| Databáze: | OpenAIRE |
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