Abstract 813: Liver Function Markers and Mortality in Patients with Chronic Heart Failure
The syndrome of chronic heart failure (CHF) involves many organs and systems. Limited data on liver function and mortality is available for patients with CHF. We assessed laboratory markers of liver function and potential association with long-term mortality in an unselected cohort of patients with CHF. In our population based survey, we screened all discharges and deaths in community hospital (population 125.000). From 2001 to 2003, 638 patients (73±10 years, 48% men, 74% NYHA class III) who were discharged alive and had diagnosis of CHF according to ICD 10 were identified. Medical charts were reviewed and vital status was obtained from a Central Population Registry. Liver function was estimated by AST, ALT, gamma-GT (GGT), and alkaline phospathase (AP). At least one marker of liver function was elevated in 35% of patients. Individual markers were elevated in following proportions: GGT 29%, AST 15%, ALT 11%, and AP 7%. During follow-up, 396 patients died (12- and 36-months mortality rates 28% [24%–31%] and 50% [46%–54%], respectively). Mortality in patients without pathologic values of liver markers was significantly lower (57% vs 68%, p=0.007). In Kaplan-Meier analysis, patients with normal GGT concentration (<0.92 μkat/l) had better survival (log rank test p=0.0002). In Cox proportional hazard analysis, elevated level of GGT (HR 1.51, 95% CI 1.22–1.87), GGT quartiles (HR 1.17, 95% CI 1.07–1.28) and at least marker of liver function above normal (HR 1.13, 95% CI 1.02–1.25) were associated with higher risk of death. After adjustment for age, gender, hemoglobin, total cholesterol, eGFR, and treatment with beta blockers in two different models, elevated level of GGT (HR 1.88, 95% CI 1.47–2.40) or GGT quartiles (HR 1.17, 95% CI 1.02–1.35) remained independent predictors of mortality. In a large unselected cohort of patients with CHF, laboratory parameters of liver function were abnormal in 35%. GGT was an independent predictor of mortality.