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Systolic blood pressure and cardiac mortality related to serum total bilirubin levels at admission in patients with acute heart failure

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Abstract

The impact of elevated total bilirubin (Tbil) levels on adverse clinical outcomes in patients with acute heart failure (HF) has not been fully established, although liver damage is common among these patients. We therefore examined the associations between Tbil levels at admission and systolic blood pressure (SBP) in patients with acute HF in an emergency setting and to evaluate clinical outcomes related to elevated Tbil, particularly in patients with SBP < 100 mmHg. Clinical data and outcomes in acute HF patients (n = 877) were compared according to Tbil quartiles. SBP values < 100 mmHg were more prevalent among patients in the highest quartile (Tbil ≥ 1.0 mg/dL) vs. others (15.4% vs. 3.1%, p < 0.001). Tbil levels were inversely and significantly correlated with SBP at admission (Spearman’s ρ, − 0.243; p < 0.001). Kaplan–Meier estimate survival curves showed that event-free survival was worse among patients in the highest Tbil quartile vs. others (78.5% vs. 90.4%, p < 0.001). When comparing survival rates among patients in SBP < 100 mmHg (n = 50), the difference of survival rate became larger for the patients in the highest quartile (n = 29) vs. others (n = 21) (41.4% vs. 77.7%, p < 0.001). Multivariate Cox proportional hazard analysis showed that Tbil ≥ 1.3 mg/dL, not SBP or B-type natriuretic peptide, independently and significantly predicted cardiac death within 180 days in acute HF patients with SBP < 100 mmHg (hazard ratio 3.74; 95% confidence interval 1.39–10.05; p < 0.001). In conclusion, Tbil levels were inversely correlated with SBP at admission in patients with acute HF. Tbil levels independently predicted the risk of 180-day cardiac mortality, especially in acute HF patients with SBP < 100 mmHg.

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References

  1. Ambrosy AP, Fonarow GC, Butler J, Chioncel O, Greene SJ, Vaduganathan M, Nodari S, Lam CSP, Sato N, Shah AN, Gheorghiade M (2014) The global health and economic burden of hospitalizations for heart failure: lessons learned from hospitalized heart failure registries. J Am Coll Cardiol 63:1123–1133

    Article  Google Scholar 

  2. Shirakabe A, Kobayashi N, Okazaki H, Matsushita M, Shibata Y, Goda H, Shigihara S, Asano K, Kiuchi K, Hata N, Asai K, Shimizu W (2019) Trends in the Management of Acute Heart Failure Requiring Intensive Care. Am J Cardiol 124:1076–1084

    Article  CAS  Google Scholar 

  3. Shirakabe A, Hata N, Kobayashi N, Okazaki H, Matsushita M, Shibata Y, Nishigoori S, Uchiyama S, Asai K, Shimizu W (2018) The prognostic impact of malnutrition in patients with severely decompensated acute heart failure, as assessed using the Prognostic Nutritional Index (PNI) and Controlling Nutritional Status (CONUT) score. Heart Vessels 33:134–144

    Article  Google Scholar 

  4. Kearney MT, Fox KAA, Lee AJ, Prescott RJ, Shah AM, Batin PD, Baig W, Lindsay S, Callahan TS, Shell WE, Eckberg DL, Zaman AG, Williams S, Neilson JMM, Nolan J (2002) Predicting death due to progressive heart failure in patients with mild-to-moderate chronic heart failure. J Am Coll Cardiol 40:1801–1808

    Article  Google Scholar 

  5. Gheorghiade M, Abraham WT, Albert NM, Greenberg BH, O’Connor CM, She L, Stough WG, Yancy CW, Young JB, Fonarow GC (2006) Systolic blood pressure at admission, clinical characteristics, and outcomes in patients hospitalized with acute heart failure. JAMA 296:2217–2226

    Article  CAS  Google Scholar 

  6. Zannad F, Mebazaa A, Juilliere Y, Cohen-Solal A, Guize L, Alla F, Rouge P, Blin P, Barlet MH, Paolozzi L, Vincent C, Desnos M, Samii K, Investigators E (2006) Clinical profile, contemporary management and one-year mortality in patients with severe acute heart failure syndromes: the EFICA study. Eur J Heart Fail 8:697–705

    Article  Google Scholar 

  7. Fonarow GC, Adams KF Jr, Abraham WT, Yancy CW, Boscardin WJ (2005) Risk stratification for in-hospital mortality in acutely decompensated heart failure: classification and regression tree analysis. JAMA 293:572–580

    Article  CAS  Google Scholar 

  8. Nohria A, Tsang SW, Fang JC, Lewis EF, Jarcho JA, Mudge GH, Stevenson LW (2003) Clinical assessment identifies hemodynamic profiles that predict outcomes in patients admitted with heart failure. J Am Coll Cardiol 41:1797–1804

    Article  Google Scholar 

  9. Cheng V, Kazanagra R, Garcia A, Lenert L, Krishnaswamy P, Gardetto N, Clopton P, Maisel A (2001) A rapid bedside test for B-type peptide predicts treatment outcomes in patients admitted for decompensated heart failure: a pilot study. J Am Coll Cardiol 37:386–391

    Article  CAS  Google Scholar 

  10. Mebazaa A, Gheorghiade M, Pina IL, Harjola VP, Hollenberg SM, Follath F, Rhodes A, Plaisance P, Roland E, Nieminen M, Komajda M, Parkhomenko A, Masip J, Zannad F, Filippatos G (2008) Practical recommendations for prehospital and early in-hospital management of patients presenting with acute heart failure syndromes. Crit Care Med 36:S129–139

    Article  Google Scholar 

  11. van Deursen VM, Damman K, Hillege HL, van Beek AP, van Veldhuisen DJ, Voors AA (2010) Abnormal liver function in relation to hemodynamic profile in heart failure patients. J Card Fail 16:84–90

    Article  Google Scholar 

  12. Shinagawa H, Inomata T, Koitabashi T, Nakano H, Takeuchi I, Naruke T, Ohsaka T, Nishii M, Takehana H, Izumi T (2008) Prognostic significance of increased serum bilirubin levels coincident with cardiac decompensation in chronic heart failure. Circ J 72:364–369

    Article  CAS  Google Scholar 

  13. Chintanaboina J, Haner MS, Sethi A, Patel N, Tanyous W, Lalos A, Pancholy S (2013) Serum bilirubin as a prognostic marker in patients with acute decompensated heart failure. Korean J Intern Med 28:300–305

    Article  CAS  Google Scholar 

  14. Nikolaou M, Parissis J, Yilmaz MB, Seronde MF, Kivikko M, Laribi S, Paugam-Burtz C, Cai D, Pohjanjousi P, Laterre PF, Deye N, Poder P, Cohen-Solal A, Mebazaa A (2013) Liver function abnormalities, clinical profile, and outcome in acute decompensated heart failure. Eur Heart J 34:742–749

    Article  Google Scholar 

  15. Gheorghiade M, Zannad F, Sopko G, Klein L, Pina IL, Konstam MA, Massie BM, Roland E, Targum S, Collins SP, Filippatos G, Tavazzi L (2005) Acute heart failure syndromes: current state and framework for future research. Circulation 112:3958–3968

    Article  Google Scholar 

  16. Nieminen MS, Harjola VP (2005) Definition and epidemiology of acute heart failure syndromes. Am J Cardiol 96:5g–10g

    Article  Google Scholar 

  17. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, Gonzalez-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P (2016) 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 37:2129–2200

    Article  Google Scholar 

  18. Ambrosy AP, Vaduganathan M, Huffman MD, Khan S, Kwasny MJ, Fought AJ, Maggioni AP, Swedberg K, Konstam MA, Zannad F, Gheorghiade M, investigators Et (2012) 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. Eur J Heart Fail 14:302–311

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Tokyo, Japan

    Reiko Shiomura

  2. Cardiovascular Center, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamagari, Inzai, Chiba, 270-1694, Japan

    Nobuaki Kobayashi & Miyauchi Yasushi

  3. Division of Intensive Care Unit, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Chiba, Japan

    Akihiro Shirakabe, Hirotake Okazaki, Yusaku Shibata, Hata Noritake & Kuniya Asai

  4. Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan

    Wataru Shimizu

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  1. Reiko Shiomura
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  2. Nobuaki Kobayashi
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  3. Akihiro Shirakabe
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  4. Hirotake Okazaki
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  5. Yusaku Shibata
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  6. Miyauchi Yasushi
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  7. Hata Noritake
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  8. Kuniya Asai
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  9. Wataru Shimizu
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Correspondence to Nobuaki Kobayashi.

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Shiomura, R., Kobayashi, N., Shirakabe, A. et al. Systolic blood pressure and cardiac mortality related to serum total bilirubin levels at admission in patients with acute heart failure. Heart Vessels 36, 69–75 (2021). https://doi.org/10.1007/s00380-020-01666-1

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  • DOI: https://doi.org/10.1007/s00380-020-01666-1

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