Abstract 13219: Prognostic Value of Direct Bilirubin in Acute Decompensated Heart Failure
Background: Where total bilirubin is known as a strong prognostic predictor in chronic heart failure, prognostic role of bilirubin fractionation in acute decompensated heart failure (ADHF) is unknown. Increased serum direct bilirubin (DB) is known to occur by cholestasis or acute liver injury. The present study was conducted to investigate the impact of bilirubin fractionation on mortality in patients with ADHF from the prospective registry of our institution.
Method: We studied 307 consecutive patients admitted for ADHF from January 2013 to January 2014. All patients had initial bilirubin values available, taken within 24 hours from admission. Patients’ basic characteristics data including sex, age, past medical history, medications, blood tests, and echocardiography were analyzed. Additionally, hemodynamic parameters in 37 patients who underwent initial right heart catheterization were analyzed. All-cause mortality was set as a primary endpoint in this study.
Results: Of the 307 patients (75.5±12.0 years, 197 male), 21 patients (7%) died during a mean follow up period of 231 days. There were no significant differences in age, sex, use of ACEI/ARB/beta-blockers between patients with adverse event and those without. DB level was significantly higher in the event group (0.5±0.3 vs. 0.3±0.3 IU/l, p=0.02). Kaplan-Meier survival curves demonstrated that abnormal DB level of >0.4 IU/L was associated with significantly poorer clinical outcome in ADHF patients (p=0.007), whereas abnormal indirect bilirubin level of >0.8IU/L was not (p=0.74). Cox proportional hazards regression analysis showed that DB level is an independent predictor of all-cause mortality (HR=24.6, p=0.04) among variables including age, sex, serum Na concentration, plasma BNP, and left ventricular ejection fraction. In addition, patients with elevated DB had higher central venous pressure (16±10 vs. 7±5mmHg, p=0.001) and tended to have lower cardiac index (1.8±0.7 vs. 2.2±0.7 L/min/m2, p=0.12).
Conclusion: Abnormal DB level is a novel and powerful predictor of all-cause mortality in ADHF. Systemic venous congestion due to right heart failure may cause cholestasis and acute liver injury, resulting in elevation of serum DB level.
Author Disclosures: A. Okada: None. Y. Sugano: None. T. Nagai: None. T. Yamane: None. T. Shibata: None. K. Nakamura: None. N. Iwakami: None. D. Chinen: None. Y. Asaumi: None. T. Aiba: None. T. Noguchi: None. M. Ishihara: None. K. Kusano: None. H. Ogawa: None. S. Yasuda: None. T. Anzai: None.
- © 2014 by American Heart Association, Inc.