title: Liver function abnormalities and outcome in patients with chronic heart failure: data from the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) program.
abstract: OBJECTIVE
  The prevalence and importance of liver function test (LFT) abnormalities in a large contemporary cohort of heart failure patients have not been systematically evaluated.
  
  
  RESULTS
  We characterized the LFTs of 2679 patients with symptomatic chronic heart failure from the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity program (CHARM). We used multivariable modelling to assess the relationships between baseline LFT values and long-term outcomes. Liver function test abnormalities were common in patients with chronic heart failure, ranging from alanine aminotransferase elevation in 3.1% of patients to low albumin in 18.3% of patients; total bilirubin was elevated in 13.0% of patients. In multivariable analysis, elevated total bilirubin was the strongest LFT predictor of adverse outcome for both the composite outcome of cardiovascular death or heart failure hospitalization (HR 1.21 per 1 SD increase, P<0.0001) and all-cause mortality (HR 1.19 per 1 SD increase, P<0.0001). Even after adjustment for other variables, elevated total bilirubin was one of the strongest independent predictors of poor prognosis (by global chi-square).
  
  
  CONCLUSIONS
  Bilirubin is independently associated with morbidity and mortality. Changes in total bilirubin may offer insight into the underlying pathophysiology of chronic heart failure.
authors.affiliation: Division of Cardiology, University of Colorado Denver, Aurora, CO, USA.
authors.forename: Larry A
authors.initials: LA
authors.lastname: Allen
authors.forename: G Michael
authors.initials: GM
authors.lastname: Felker
authors.forename: Stuart
authors.initials: S
authors.lastname: Pocock
authors.forename: John J V
authors.initials: JJ
authors.lastname: McMurray
authors.forename: Marc A
authors.initials: MA
authors.lastname: Pfeffer
authors.forename: Karl
authors.initials: K
authors.lastname: Swedberg
authors.forename: Duolao
authors.initials: D
authors.lastname: Wang
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
authors.forename: Eric L
authors.initials: EL
authors.lastname: Michelson
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Granger
mesh_terms: D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000469:Alkaline Phosphatase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D002908:Chronic Disease; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D006760:Hospitalization; D006801:Humans; D008107:Liver Diseases / Q000150:complications / Q000175:diagnosis; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012709:Serum Albumin / Q000032:analysis; D016277:Ventricular Function, Left
chemical_list: D012709:Serum Albumin; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase; D001663:Bilirubin