Miyama Hiroshi, Shiraishi Yasuyuki, Kohsaka Shun, Goda Ayumi, Nishihata Yosuke, Nagatomo Yuji, Takei Makoto, Fukuda Keiichi, Kohno Takashi, Yoshikawa Tsutomu
Department of Cardiology, Keio University School of Medicine, Tokyo 160-8582, Japan.
Division of Cardiovascular Medicine, Kyorin University School of Medicine, Tokyo 181-8611, Japan.
J Clin Med. 2021 Apr 16;10(8):1730. doi: 10.3390/jcm10081730.
Abnormal liver function tests (LFTs) are known to be associated with impaired clinical outcomes in heart failure (HF) patients. However, this implication varies with each single LFT panel. We aim to evaluate the long-term outcomes of acute HF (AHF) patients by assessing multiple LFT panels in combination. From a prospective multicenter registry in Japan, 1158 AHF patients who were successfully discharged were analyzed (mean age, 73.9 ± 13.5 years; men, 58%). LFTs (i.e., total bilirubin, aspartate aminotransferase or alanine aminotransferase, and alkaline phosphatase) at discharge were assessed; borderline and abnormal LFTs were defined as 1 and ≥2 parameter values above the normal range, respectively. The primary endpoint was composite of all-cause death or HF readmission. At the time of discharge, 28.7% and 8.6% of patients showed borderline and abnormal LFTs, respectively. There were 196 (16.9%) deaths and 298 (25.7%) HF readmissions during a median 12.4-month follow-up period. The abnormal LFTs group had a significantly higher risk of experiencing the composite outcome (adjusted hazard ratio: 1.51, 95% confidence interval: 1.08-2.12, = 0.017), whereas the borderline LFTs group was not associated with higher risk of adverse events when referenced to the normal LFTs group. Among AHF patients, the combined elevation of ≥2 LFT panels at discharge was associated with long-term adverse outcomes.
已知肝功能检查（LFTs）异常与心力衰竭（HF）患者临床预后受损相关。然而，这种关联在每个单独的LFT指标中有所不同。我们旨在通过联合评估多个LFT指标来评估急性心力衰竭（AHF）患者的长期预后。从日本一项前瞻性多中心登记研究中，分析了1158例成功出院的AHF患者（平均年龄73.9±13.5岁；男性占58%）。评估出院时的LFTs（即总胆红素、天冬氨酸转氨酶或丙氨酸转氨酶以及碱性磷酸酶）；临界和异常LFTs分别定义为高于正常范围的1个和≥2个参数值。主要终点是全因死亡或HF再入院的复合终点。出院时，分别有28.7%和8.6%的患者LFTs处于临界和异常状态。在中位12.4个月的随访期内，有196例（16.9%）死亡和298例（25.7%）HF再入院。LFTs异常组发生复合结局的风险显著更高（调整后风险比：1.51，95%置信区间：1.08 - 2.12，P = 0.017），而与正常LFTs组相比，临界LFTs组与不良事件风险升高无关。在AHF患者中，出院时≥2个LFT指标联合升高与长期不良预后相关。
