title: Evidence of Mild Liver Dysfunction Identifies Stable Heart Failure Outpatients with Reversible Renal Dysfunction.
abstract: BACKGROUND
  In decompensated heart failure (HF), reversible renal dysfunction (RD) is more frequently observed in patients with mild liver dysfunction likely due to the shared pathophysiologic factors involved. The objective of this study was to determine if these findings also apply to stable HF outpatients.
  
  
  METHODS
  Patients in the Beta-Blocker Evaluation of Survival Trial (BEST) were studied. Improvement in renal function (IRF) was defined as a 20% improvement in the estimated glomerular filtration rate from baseline to 3 months.
  
  
  RESULTS
  Elevated bilirubin (BIL), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were significantly associated with signs of congestion or poor perfusion. IRF occurred in 12.0% of all patients and was more common in those with elevated BIL (OR = 1.5, p = 0.003), ALT (OR = 1.4, p = 0.01), and AST (OR = 1.4, p = 0.01). In a model containing all 3 liver parameters and baseline characteristics, including markers of congestion/poor perfusion, BIL (OR = 1.6, p = 0.001) and ALT (OR = 1.7, p < 0.001) were independently associated with IRF.
  
  
  CONCLUSIONS
  Biochemical evidence of mild liver dysfunction is significantly associated with IRF in stable HF outpatients. Given the widespread availability and low cost of these markers, additional research is necessary to determine the utility of these parameters in identifying patients with reversible RD who may benefit from cardiorenal interventions.
authors.affiliation: Cardiology Division, Department of Medicine, Medical University of South Carolina, Charleston, S.C., USA.
authors.forename: Meredith A
authors.initials: MA
authors.lastname: Brisco
authors.affiliation: Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn., USA.
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Cheng
authors.affiliation: Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn., USA.
authors.forename: Olga
authors.initials: O
authors.lastname: Laur
authors.affiliation: Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn., USA.
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Kula
authors.affiliation: Program of Applied Translational Research, Yale University School of Medicine, New Haven, Conn., USA ; Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn., USA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Testani
keywords: Cardiorenal syndrome; Heart failure; Liver dysfunction