title: Liver function tests in patients with acute heart failure and associated outcomes: insights from ASCEND-HF.
abstract: We aimed to characterize abnormal liver function tests in patients with heart failure (HF), as they are commonly encountered yet poorly defined.
  
  
  
  We used data from ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure) to characterize associations with baseline liver function tests (LFTs). Each LFT was analysed as both a continuous and dichotomous variable [normal vs. abnormal; bilirubin >1.0 mg/dL; aspartate aminotransferase (AST) and alanine aminotransferase (ALT) >35 mmol/L]. Logistic regression assessed the association of LFTs and 30-day all-cause mortality and HF rehospitalization, and Cox proportional hazards assessed the association with 180-day all-cause mortality among patients alive at a 30-day landmark. In ASCEND-HF, 4228 (59%) had complete admission LFT data. Of these, 42% had abnormal bilirubin, 22% had abnormal ALT, and 30% had abnormal AST. Patients with abnormal LFTs were younger, had lower body mass index, and lower left ventricular ejection fraction. In multivariable models, increased total bilirubin was associated with increased 30-day mortality or HF rehospitalization [hazard ratio (HR) 1.17 per 1 mg/dL increase, 95% confidence interval (CI) 1.04, 1.32; P = 0.012], but not with an increase in 180-day mortality (HR 1.10, 95% CI 0.97, 1.25; P = 0.13) per 1 mg/dl increase. Compared with normal bilirubin levels, abnormal bilirubin was associated with increased 30-day mortality or HF rehospitalization (HR 1.24, 95% CI 1.00, 1.54; P = 0.048) and 180-day mortality (HR 1.32, 95% CI 1.08, 1.62; P = 0.007). We found no association with AST or ALT and outcomes.
  
  
  
  Greater than 40% of patients hospitalized with acute HF had abnormal LFTs. After multivariable adjustment, only elevated bilirubin was independently associated with worse clinical outcomes and may represent an important prognostic variable.
authors.affiliation: Duke University, Durham, NC, USA.
authors.forename: Marc D
authors.initials: MD
authors.lastname: Samsky
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: Allison
authors.initials: A
authors.lastname: Dunning
authors.affiliation: Duke University, Durham, NC, USA.|Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: Adam D
authors.initials: AD
authors.lastname: DeVore
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Schulte
authors.affiliation: Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Randall C
authors.initials: RC
authors.lastname: Starling
authors.affiliation: Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: W H Wilson
authors.initials: WH
authors.lastname: Tang
authors.affiliation: Canadian VIGOUR Centre.|University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Armstrong
authors.affiliation: University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Justin A
authors.initials: JA
authors.lastname: Ezekowitz
authors.affiliation: Stony Brook University Hospital, Stony Brook, NY, USA.
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
authors.affiliation: Glasgow Cardiovascular Research Centre.|University of Glasgow,, Glasgow, UK.
authors.forename: John J
authors.initials: JJ
authors.lastname: McMurray
authors.affiliation: San Francisco VA Hospital, University of California, San Francisco and San Francisco VAMC, San Francisco, CA, USA.
authors.forename: John R
authors.initials: JR
authors.lastname: Teerlink
authors.affiliation: University of Groningen, Groningen, the Netherlands.
authors.forename: Adrian A
authors.initials: AA
authors.lastname: Voors
authors.affiliation: University of Brescia, Brescia, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
authors.affiliation: Duke University, Durham, NC, USA.|Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Mentz
authors.affiliation: Duke University, Durham, NC, USA.|Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.affiliation: Duke University, Durham, NC, USA.|Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: Chetan B
authors.initials: CB
authors.lastname: Patel
authors.affiliation: Duke University, Durham, NC, USA.|Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
mesh_terms: D000208:Acute Disease; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood*; D001219:Aspartate Aminotransferases / Q000097:blood*; D001663:Bilirubin / Q000097:blood*; D002423:Cause of Death; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000503:physiopathology; D006801:Humans; D008111:Liver Function Tests; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D010359:Patient Readmission; D011379:Prognosis; D016016:Proportional Hazards Models; D013318:Stroke Volume
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D001663:Bilirubin
keywords: Heart failure; Liver function tests; Outcomes