Bilirubin as a prognostic marker in patients with pulmonary arterial hypertension.
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.
Takeda
Yasuko
Y
Department of Cardio-renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan.
Takeda
Yutaka
Y
Tomimoto
Shigehiro
S
Tani
Tomomitsu
T
Narita
Hitomi
H
Kimura
Genjiro
G
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
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain; D001663:Bilirubin