title: Concomitant renal and hepatic dysfunctions in chronic heart failure: clinical implications and prognostic significance.
abstract: BACKGROUND
  The cardio-renal syndrome is common and eGFR is an established biomarker in chronic heart failure (CHF). Recent findings also indicate a predictive role of liver function abnormalities such as GGT in CHF. We aimed to jointly investigate the characteristics and importance of renal and hepatic failure in CHF.
  
  
  METHODS
  Clinical and laboratory parameters of 1290 ambulatory patients (NYHA class I 25%, II 47%, III/IV 27%; median LV-EF 29%) were evaluated. Hemodynamics was available in 253 patients. The endpoint was defined as death from any cause or heart transplantation.
  
  
  RESULTS
  eGFR <60mL/min and GGT elevations were highly prevalent (25% and 44%, respectively; 12.8% for both). Renal and hepatic dysfunctions were correlated with disease severity and independently associated with adverse outcome in univariate (p<0.001) and multivariate analyses (p=0.012 and p<0.001, respectively). Signs of congestion and elevated CVP but not CI were independent predictors of changes in eGFR and GGT. In patients with concurrent impairment of both organs estimated five-year event rate was 46% as compared to 25% in patients with eGFR and GGT in the normal ranges (HR 3.12, 95% CI 2.33-4.18; p<0.001).
  
  
  CONCLUSIONS
  Impairment of renal and hepatic function is related to functional status and a poor prognosis in patients with mild to moderate heart failure. Concurrent involvement of both organs indicates disease progression and further elevates the hazard for adverse outcomes. Moreover, our data suggest that venous congestion rather than forward failure accounts for the development of renal and hepatic dysfunctions in these patients.
authors.affiliation: Dep. of Internal Medicine III, Cardiology, Innsbruck Medical University, Austria. gerhard.poelzl@uki.at
authors.forename: Gerhard
authors.initials: G
authors.lastname: Poelzl
authors.forename: Michael
authors.initials: M
authors.lastname: Ess
authors.forename: Andreas
authors.initials: A
authors.lastname: Von der Heidt
authors.forename: Michael
authors.initials: M
authors.lastname: Rudnicki
authors.forename: Matthias
authors.initials: M
authors.lastname: Frick
authors.forename: Hanno
authors.initials: H
authors.lastname: Ulmer
mesh_terms: D000328:Adult; D000368:Aged; D059347:Cardio-Renal Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D017093:Liver Failure / Q000175:diagnosis / Q000201:enzymology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D005723:gamma-Glutamyltransferase / Q000097:blood*
chemical_list: D005723:gamma-Glutamyltransferase