Evidence of mild liver dysfunction identifies stable heart failure outpatients with reversible renal dysfunction

Meredith A. Brisco, Susan J. Cheng, Olga Laur, Alexander J. Kula, Jeffrey M. Testani

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: In decompensated heart failure (HF), reversible renal dysfunction (RD) is more frequently observed in patients with mild liver dysfunction likely due to the shared pathophysiologic factors involved. The objective of this study was to determine if these findings also apply to stable HF outpatients. Methods: Patients in the Beta-Blocker Evaluation of Survival Trial (BEST) were studied. Improvement in renal function (IRF) was defined as a 20% improvement in the estimated glomerular filtration rate from baseline to 3 months. Results: Elevated bilirubin (BIL), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were significantly associated with signs of congestion or poor perfusion. IRF occurred in 12.0% of all patients and was more common in those with elevated BIL (OR = 1.5, p = 0.003), ALT (OR = 1.4, p = 0.01), and AST (OR = 1.4, p = 0.01). In a model containing all 3 liver parameters and baseline characteristics, including markers of congestion/poor perfusion, BIL (OR = 1.6, p = 0.001) and ALT (OR = 1.7, p < 0.001) were independently associated with IRF. Conclusions: Biochemical evidence of mild liver dysfunction is significantly associated with IRF in stable HF outpatients. Given the widespread availability and low cost of these markers, additional research is necessary to determine the utility of these parameters in identifying patients with reversible RD who may benefit from cardiorenal interventions.

Original languageEnglish (US)
Pages (from-to)229-236
Number of pages8
JournalCardioRenal Medicine
Issue number3
StatePublished - Jun 15 2015
Externally publishedYes


  • Cardiorenal syndrome
  • Heart failure
  • Liver dysfunction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Urology


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