ABSTRACT
Objectives: The objective of this study characterize abnormal liver function test after recovered coronavirus in patients with heart failure (HF) as they are commonly encountered yet poorly defined. Materials and Methods: This study is a Clinical Effectiveness of nesiritide in decompensated Heart Failure use data from SCEND-HF to characterize associations with baseline liver function tests (LFTs). each LFT was analysed as both a continuous and dichotomous variable >normal vs. abnormal;bilirubin>1.0 mg/dL;aspartate aminotransferase (AST) and alanine aminotransferase ALT>35 mmol/L. Results: Mean Logistic regression assessed the association of LFTs and 30-day all-cause mortality and HF rehospitalization, and Cox proportional hazards assessed the association with 180-day all-cause mortality among patients alive at a 30-day landmark. In SCEND-HF, 2128 (48%) had complete admission LFT data. of these, 39% had abnormal bilirubin, 22% had abnormal ALT, and 29% had abnormal AST. Patients with abnormal LFTs were younger, had lower body mass index, and lower left ventricular ejection fraction. In multivariable models, increased total bilirubin was associated with increased 30-day mortality or HF rehospitalization >hazard ratio (HR) 1.17 per 1 mg/dL increase 85% confidence interval (CI) 1.04, 1.32;P = 0.012], but not with an increase in 180-day mortality (HR 1.10, 95% CI 0.97, 1.25;P = 0.13) per 1 mg/dl increase. Compared with normal bilirubin levels, abnormal bilirubin was associated with increased 30-day mortality or HF rehospitalization (HR 1.24, 95% CI 1.00, 1.54;P = 0.048) and 180-day mortality (HR 1.32, 95% CI 1.08, 1.62;P = 0.007). We found no association with AST or ALT and outcomes. Conclusion: More than 40% of patients Hospitalized with acute HF had abnormal LFTS.After multivariable regulation, only High bilirubin was independently related with worse clinical outcomes and may represent an important prognostic variable.
ABSTRACT
Objectives: Recent studies indicate the need to redefine renal function (RF) in acute heart failure (AHF) linking a rise in creatinine with clinical status to identify patients who develop evaluated the usefulness of serial assessment of urinary levels of neutrophil gelatinaseassociated lipocalin kidney injury molecule-1 (KIM-1). Materials and Methods: In 96 patients with AHF, uNGAL, uKIM-1, and uCysC were measured using a highly sensitive immunoassay based on a single-molecule counting technology (Singulex, Alameda, CA, USA) at baseline, day 2, and day 3. Patients who developed WRF (a ≥ 0.3 mg/dL increase in serum creatinine or a >25% decrease in the estimated glomerular filtration rate from the baseline value). Results: were differentiated into those presence of deterioration/no improvement in clinical status during hospitalization vs. 'pseudo-WRF' (uneventful clinical course). occurred in 12 (10%), 'pseudo-WRF' in 14 (11%), whereas the remaining 104 (79%) patients did not develop WRF. Patients with 'true WRF' were more often females, had higher levels of NT-proBNP, creatinine, and urea on admission, higher urine albumin to creatinine ratio at day 2, higher uNGAL at baseline, day 2, and day 3, and higher KIM-1 at day 2 (vs. pseudo-WRF vs. without WRF, all P<0.05). Patients with pseudo-WRF did not differ from those without WRF. In the multivariable model, elevated uNGAL at all time points and KIM-1 at day 2 remained independent predictors. Conclusion: identify patients at high risk of death. Larger studies with more frequent biomarker assessments in the early stages of hospitalization are needed to portray the dynamics of these patients in a realistic way, to better demonstrate the usefulness of biomarkers.