title: Bilirubin as a prognostic marker in patients with pulmonary arterial hypertension.
abstract: BACKGROUND
  Liver dysfunction reflects the status of heart failure, with congestion and low perfusion of the liver serving as causative mechanisms. Previous studies demonstrated relationship between the results of liver function test and the prognosis in patients with heart failure. However, few studies have examined this relationship in patients with pulmonary arterial hypertension (PAH).
  
  
  METHODS
  The subjects were 37 patients with PAH (8 men and 29 women; 18 with idiopathic PAH and 19 with connective tissue disease-associated PAH). A blood test was performed after a 3-month period free from hospitalization and without changes in functional class, treatment, heart sounds, body weight, or heart rate.
  
  
  RESULTS
  In a mean follow-up period of 635 +/- 510 days, 12 patients died due to heart failure, 2 died due to pulmonary hemorrhage, and 23 patients survived. Cox proportional hazard analyses identified functional class (p < 0.001), plasma concentration of brain natriuretic peptide (BNP) (p = 0.001), and hyperbilirubinemia (serum total bilirubin > 1.2 mg/dL; p < 0.001; hazard ratio = 13.31) as predictors of mortality. Patients with hyperbilirubinemia had a worse functional class (P = 0.003), a higher right atrial pressure (p < 0.001), a higher plasma concentration of BNP (p = 0.004), and a larger Doppler right ventricular index of the right ventricle (p = 0.041).
  
  
  CONCLUSIONS
  Elevated serum bilirubin is a risk factor for death in patients with PAH.
authors.affiliation: Department of Cardio-renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan.
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Takeda
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Takeda
authors.forename: Shigehiro
authors.initials: S
authors.lastname: Tomimoto
authors.forename: Tomomitsu
authors.initials: T
authors.lastname: Tani
authors.forename: Hitomi
authors.initials: H
authors.lastname: Narita
authors.forename: Genjiro
authors.initials: G
authors.lastname: Kimura
mesh_terms: D000328:Adult; D000368:Aged; D001663:Bilirubin / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D006932:Hyperbilirubinemia / Q000097:blood* / Q000150:complications; D006976:Hypertension, Pulmonary / Q000097:blood* / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain; D001663:Bilirubin