Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
Eur J Heart Fail. 2012 Mar;14(3):302-11. doi: 10.1093/eurjhf/hfs007.
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.
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.
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.
肝功能异常（LFT）在门诊心力衰竭（HF）中很常见。本研究的目的是描述指数住院期间的异常 LFT。
对 EVEREST（血管加压素拮抗剂治疗心力衰竭结局试验与托伐普坦）试验安慰剂组进行了一项事后分析，该试验纳入了因射血分数（EF）≤40%且无原发性显著肝脏疾病或急性肝衰竭病史而住院治疗 HF 的患者。测定了包括血清白蛋白（ALB，<3.3 g/dL）、天门冬氨酸转氨酶（AST，>34 IU/L）、丙氨酸转氨酶（ALT，>34 IU/L）、碱性磷酸酶（AP，>123 IU/L）、γ-谷氨酰转移酶（GGT，>50 IU/L）和总胆红素（T Bili，>1.2 mg/dL）在内的 LFT（缩写，异常值的截断值），在基线、出院/第 7 天和出院后进行测量。主要复合终点为全因死亡率（ACM）和心血管死亡率或首次 HF 住院（CVM+HFH）。研究参与者的平均年龄为 65.6±12.0 岁，主要为男性，报告有很高的合并症患病率，并且接受了基于证据的治疗。基线 LFT 异常较为常见（ALB 17%，AST 21%，ALT 21%，AP 23%，GGT 62%，T Bili 26%）。从基线（26%）到出院/第 7 天（19%），只有 T Bili 显著下降。除了 AP，所有 LFT 在出院后都有所改善。较低的基线 ALB 和升高的 T Bili 与更高的 ACM 发生率相关，而住院期间 ALB 的降低和 T Bili 的升高与 ACM 和 CVM+HFH 的发生率均升高相关。
EF 降低的 HF 住院患者中，LFT 异常很常见，出院时仍持续存在。基线和住院期间 ALB 和 T Bili 的变化提供了额外的预后价值。
