title: Liver cytolysis in acute heart failure: What does it mean? Clinical profile and outcomes of a prospective hospital cohort.
abstract: Abnormal liver function tests (LFTs) are a common manifestation of heart failure (HF). Our purpose was to characterize patients hospitalized for acute HF (AHF) with liver cytolysis, analyze cytolysis predictors and explore its prognostic implications.
  
  
  METHODS
  In a prospective cohort study, we enrolled patients with AHF consecutively admitted to the Internal Medicine Department of University Hospital between January 2009 and December 2010, and recorded demographic, clinical, laboratory and echocardiogram parameters. A logistic regression was done to identify cytolysis predictors. In survival analysis primary endpoints were all-cause death, readmission due to AHF, and the combined event of all-cause death and readmission for AHF at 90days of follow-up.
  
  
  RESULTS
  Fifty-eight patients had cytolysis at admission. AHF attributed to atrial fibrillation (OR 3.235), higher heart rate at admission (OR 1.028), cold/wet profile at admission (OR 7.12) and ejection fraction <30% (OR 2.316) were independent predictors of cytolysis. Death occurred more frequently during follow-up in the cytolysis group (27.6 vs. 15.1%, p=0.014, respectively). On survival analysis, cytolysis remained an independent predictor of death at 90days when adjusted to age (HR 1.066), male gender (HR 1.884), valvular etiology (HR 2.365), neurologic status at admission (sleepy HR 3.854; confusion HR 3.176) and cardiac output (HR 0.762).
  
  
  CONCLUSIONS
  Cytolysis may be a marker of systemic hypoperfusion, so strategies to improve hemodynamic profile should be considered, especially in the presence of cold/wet clinical profile, AHF attributed to AF, tachycardia, and EF<30%. Cytolysis is associated with higher mortality at 90days in patients with AHF.
authors.affiliation: Department of Internal Medicine, Centro Hospitalar São João, E.P.E., Porto, Portugal.
authors.forename: Sofia
authors.initials: S
authors.lastname: Moreira-Silva
authors.affiliation: Department of Internal Medicine, Centro Hospitalar São João, E.P.E., Porto, Portugal.
authors.forename: Joana
authors.initials: J
authors.lastname: Urbano
authors.affiliation: Department of Internal Medicine, Centro Hospitalar São João, E.P.E., Porto, Portugal.
authors.forename: Marta Casal
authors.initials: MC
authors.lastname: Moura
authors.affiliation: Department of Internal Medicine, Centro Hospitalar São João, E.P.E., Porto, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal. Electronic address: joaoferreiracoimbra@gmail.com.
authors.forename: João
authors.initials: J
authors.lastname: Ferreira-Coimbra
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal; Unit of Cardiovascular Research & Development, Faculty of Medicine, University of Porto, Porto, Portugal.
authors.forename: Paulo
authors.initials: P
authors.lastname: Bettencourt
authors.affiliation: Department of Internal Medicine, Centro Hospitalar São João, E.P.E., Porto, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal; Unit of Cardiovascular Research & Development, Faculty of Medicine, University of Porto, Porto, Portugal.
authors.forename: Joana
authors.initials: J
authors.lastname: Pimenta
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008107:Liver Diseases / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D008111:Liver Function Tests / Q000379:methods / Q000639:trends; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: Abnormal liver function; Heart failure; Liver; Transaminases