title: Clinical course and predictive value of liver function tests in patients hospitalized for worsening heart failure with reduced ejection fraction: an analysis of the EVEREST trial.
abstract: OBJECTIVE
  Abnormal liver function tests (LFTs) are common in ambulatory heart failure (HF). The aim of this study was to characterize abnormal LFTs during index hospitalization.
  
  
  RESULTS
  A post-hoc analysis was carried out of the placebo group of the EVEREST (Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan) trial, which enrolled patients hospitalized for HF with an ejection fraction (EF) ≤40% and no history of primary significant liver disease or acute hepatic failure. LFTs (abbreviation, cut-offs for abnormal values) including serum albumin (ALB, <3.3 g/dL), aspartate transaminase (AST, >34 IU/L), alanine transaminase (ALT, >34 IU/L), alkaline phosphatase (AP, >123 IU/L),γ-glutamyl transferase (GGT, >50 IU/L), and total bilirubin (T Bili, >1.2 mg/dL) were measured at baseline, discharge/day 7, and post-discharge. Co-primary endpoints were all-cause mortality (ACM) and cardiovascular mortality or first HF hospitalization (CVM + HFH). Study participants had a mean age of 65.6 ±12.0 years, were mostly male, reported high prevalences of medical co-morbidities, and were well treated with evidence-based therapies. Baseline LFT abnormalities were common (ALB 17%, AST 21%, ALT 21%, AP 23%, GGT 62%, and T Bili 26%). Abnormal T Bili was the only marker to decrease substantially from baseline (26%) to discharge/day 7 (19%). All LFTs, except AP, improved post-discharge. Lower baseline ALB and elevated T Bili were associated with higher rates of ACM, and in-hospital decreases in ALB and increases in T Bili were associated with higher rates of both ACM and CVM + HFH.
  
  
  CONCLUSIONS
  LFT abnormalities are common during hospitalization for HF in patients with reduced EF and were persistent at discharge. Baseline and in-hospital changes in ALB and T Bili provide additional prognostic value.
authors.affiliation: Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Ambrosy
authors.forename: Muthiah
authors.initials: M
authors.lastname: Vaduganathan
authors.forename: Mark D
authors.initials: MD
authors.lastname: Huffman
authors.forename: Sadiya
authors.initials: S
authors.lastname: Khan
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Kwasny
authors.forename: Angela J
authors.initials: AJ
authors.lastname: Fought
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
authors.forename: Karl
authors.initials: K
authors.lastname: Swedberg
authors.forename: Marvin A
authors.initials: MA
authors.lastname: Konstam
authors.forename: Faiez
authors.initials: F
authors.lastname: Zannad
authors.forename: Mihai
authors.initials: M
authors.lastname: Gheorghiade
mesh_terms: D000368:Aged; D000410:Alanine Transaminase; D000418:Albumins; D000469:Alkaline Phosphatase; D000704:Analysis of Variance; D001219:Aspartate Aminotransferases; D016001:Confidence Intervals; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000201:enzymology / Q000473:pathology*; D006760:Hospitalization; D006801:Humans; D008107:Liver Diseases / Q000201:enzymology / Q000401:mortality / Q000473:pathology*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D013318:Stroke Volume; D014481:United States; D016277:Ventricular Function, Left
chemical_list: D000418:Albumins; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase