Clinical course and predictive value of liver function tests in patients hospitalized for worsening heart failure with reduced ejection fraction: An analysis of the EVEREST trial

Andrew P. Ambrosy, Muthiah Vaduganathan, Mark D. Huffman, Sadiya Khan, Mary J. Kwasny, Angela J. Fought, Aldo P. Maggioni, Karl Swedberg, Marvin A. Konstam, Faiez Zannad, Mihai Gheorghiade*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

108 Scopus citations

Abstract

Aims: 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. Methods and results: 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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)302-311
Number of pages10
JournalEuropean Journal of Heart Failure
Volume14
Issue number3
DOIs
StatePublished - Mar 2012

Keywords

  • Alanine transaminase
  • Albumin
  • Alkaline phosphatase
  • Aspartate transaminase
  • Bilirubin
  • Heart failure
  • Liver function test
  • γ-Glutamyl transferase

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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