Department of Medicine, Stanford Health Care, Stockton, California, USA
Department of Hospital Medicine, University of California San Francisco, San Francisco, California, USA.
BMJ Open. 2022 Mar 30;12(3):e055216. doi: 10.1136/bmjopen-2021-055216.
To determine (1) if liver function tests (LFTs) are ordered in the emergency department (ED) in patients with suspected acute decompensated heart failure (ADHF) and (2) if the pattern of LFT abnormalities are meaningfully associated with a discharge diagnosis of ADHF among patients for whom these tests were ordered.
We conducted a single-centre retrospective cohort study of patients with suspected ADHF who were seen in an academic tertiary ED using electronic medical records.
All ED patients admitted with suspected ADHF from January 2017 to May 2018, defined as any patient who had a brain natriuretic peptide (BNP) ordered.
The primary outcome was ADHF diagnosis at discharge.
In 5323 ED patients with suspected ADHF, 60% (n=3184) had LFTs ordered; 34.6% were abnormal. Men comprised 56% of patients with abnormal LFTs and the average age was 67 years. The odds of a final diagnosis of ADHF in the univariate analysis was 59% higher in patients with abnormal LFTs (OR=1.59, (95% CI 1.35 to 1.87) p<0.001) and remained significant though attenuated after adjusting for BNP, race and ethnicity and age (ORadj=1.31 (95% CI 1.09 to 1.57), p=0.004). Likelihood ratios for abnormal and normal LFTs were 1.2 (95% CI 1.21 to 1.28) and 0.76 (95% CI 0.68 to 0.84), respectively.
A significant proportion (40%) of patients with suspected ADHF was missing LFTs in their ED workup. Among patients with LFTs, abnormal LFTs are associated with discharge diagnosis of ADHF after accounting for potential confounders, but their diagnostic value was relatively low. Future prospective studies are warranted to explore the role of LFTs in the workup of ADHF.
确定（1）怀疑急性失代偿性心力衰竭（ADHF）的患者在急诊科（ED）是否进行肝功能检查（LFT），以及（2）这些检查结果异常的患者中，LFT 异常模式是否与 ADHF 的出院诊断有明显关联。
我们使用电子病历对在学术性三级 ED 就诊的疑似 ADHF 患者进行了单中心回顾性队列研究。
2017 年 1 月至 2018 年 5 月期间，所有因疑似 ADHF 而入院的 ED 患者，定义为任何开了脑钠肽（BNP）检查的患者。
出院时的主要结局为 ADHF 诊断。
在 5323 例疑似 ADHF 的 ED 患者中，有 60%（n=3184）进行了 LFT 检查；其中 34.6%异常。异常 LFT 患者中男性占 56%，平均年龄为 67 岁。在单变量分析中，异常 LFT 患者的 ADHF 最终诊断的可能性比正常 LFT 患者高 59%（OR=1.59，（95%CI 1.35 至 1.87）p<0.001），并且在调整了 BNP、种族和年龄后仍然具有统计学意义（ORadj=1.31（95%CI 1.09 至 1.57），p=0.004）。异常和正常 LFT 的似然比分别为 1.2（95%CI 1.21 至 1.28）和 0.76（95%CI 0.68 至 0.84）。
在 ED 检查中，有相当比例（40%）的疑似 ADHF 患者未进行 LFT 检查。在进行 LFT 检查的患者中，异常 LFT 与 ADHF 的出院诊断有关，但考虑到潜在的混杂因素后，其诊断价值相对较低。未来需要进行前瞻性研究，以探讨 LFT 在 ADHF 检查中的作用。
