title: Prognostic significance of increased serum bilirubin levels coincident with cardiac decompensation in chronic heart failure.
abstract: BACKGROUND
  The aim of this study was to analyze the relationship between abnormal liver function tests (LFTs) coincident with heart failure (HF) exacerbation and subsequent long-term outcome in patients with chronic HF.
  
  
  RESULTS
  The study population consisted of 183 consecutive patients admitted for HF exacerbation with left ventricular ejection fraction < or =40%. Cox proportional hazard analysis revealed that serum total bilirubin (T-Bil) levels on admission (hazard ratio 1.896, p<0.001, 95% confidence interval 1.323-2.717), but not T-Bil at discharge or other LFTs, was an independent predictor of subsequent cardiac events after hospital discharge (cardiac death or readmission for HF exacerbation) The cardiac-event-free rates significantly decreased according to increasing tertiles of T-Bil stratified by the level of 0.7 and 1.2 mg/dl (p<0.001). T-Bil on admission had significant correlations with simultaneously-measured central venous pressure (CVP) (r=0.42, p<0.01) and cardiac index (CI) (r= -0.50, p<0.01). The patients demonstrating high CVP together with low CI showed significantly increased T-Bil compared with any other group.
  
  
  CONCLUSIONS
  Increased T-Bil coincident with cardiac decompensation predicts a worse long-term prognosis of CHF, presumably through the potential liability to both congestion and tissue hypoperfusion simultaneously when HF deteriorates.
authors.affiliation: Department of Cardio-angiology, Kitasato University School of Medicine, Sagamihara, Japan. hisahito@med.kitasato-u.ac.jp
authors.forename: Hisahito
authors.initials: H
authors.lastname: Shinagawa
authors.forename: Takayuki
authors.initials: T
authors.lastname: Inomata
authors.forename: Toshimi
authors.initials: T
authors.lastname: Koitabashi
authors.forename: Hironari
authors.initials: H
authors.lastname: Nakano
authors.forename: Ichiro
authors.initials: I
authors.lastname: Takeuchi
authors.forename: Takashi
authors.initials: T
authors.lastname: Naruke
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Ohsaka
authors.forename: Mototsugu
authors.initials: M
authors.lastname: Nishii
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Takehana
authors.forename: Tohru
authors.initials: T
authors.lastname: Izumi
mesh_terms: D000368:Aged; D001663:Bilirubin / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000502:physiology; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008099:Liver / Q000378:metabolism / Q000503:physiopathology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D001663:Bilirubin