Risk Assessment Of Liver And Kidney Function In Patients With Hospitalized Heart Failure

Part 1:Characteristic of liver function in hospitalized patients with heart failureObjective:Heart failure (HF) is often associated with liver impairment. Child-Turcotte-Pugh (CTP) scores was created based on bilirubin, albumin, prothrombin time international normalized ratio, degree of ascites and hepatic encephalopathy,and has been recommended by the U.S. FDA for evaluation of liver function. However, the use of it was uncertained in patients with HF. Our study aimed to evaluate the usefulness of CTP scores for predicting death in patients hospitalized with HF.Methods:Between March 2009 and April 2013, we consecutively enrolled a large cohort of hospitalized patients with HF according to current Chinese guidelines and diagnosed by 2 or more physicians. We collected demographic data of patients admitted to hospital and liver function was performed according to the patients’ admission. CTP scores were calculated to evaluate liver function. All patients were divided into 3 groups:CTP class A (n= 895), CTP class B (n= 207) and CTP class C (n= 23). The endpoint was all-cause death. Receiver operating characteristic (ROC) and multiple Cox proportional hazards analysis were performed to evaluate the association between CTP scores and death in every subgroups predefined. Meier Kaplane survival curve was used to determine the relationship between the improvement and mortality of patients with different CTP class before and after treatment.Results:We totally enrolled 1180 patients, and after 1-year follow up,180 deaths were identified. The rates of in-hospital and 1-year mortality tend to increase in patients with CTP class A, B, and C (0.8%,11.7%,56.5%, P< 0.001; and 9.6%, 34.5%,78.3%, P< 0.001, respectively). Multivariable Cox regression analyses showed CTP scores was significantly associated with in-hospital and 1-year mortality. The area under the curve for CTP score for prediction of in-hospital and 1-year mortality was 0.88 and 0.74. Kaplan-Meier survival analysis showed patients who improved from CTP class B or C at admission to CTP class A at discharge showed a lower risk of 1-year mortality than those with CTP class B or C at admission but did not improve at discharge.Conclusion:CTP scores significantly associated with death in patients hospitalized with HF. The improvement of CTP scores might be useful to evaluate the effect of HF management during hospitalization.Part 2:Part 1:Characteristic of renal function in hospitalized patients with heart failureObjectives:Heart failure (HF) and renal dysfunction often coexist and mutual influence each other. Neutrophil gelatinase-associated the lipocalin, (NGAL) is a member of lipocalin family. The expression of NGAL was negative in normal physiological conditions. At the time of renal ischemia, a large number of NGAL were expressed. A number of studies abroad have shown that baseline NGAL can predict deterioration of renal function and mortality in hospitalized patients with HF. This study aimed to observe the correlation of NGAL and other frequently used cardiac markers in patients with HF, and investigate distribution characteristics of NGAL in Chinese hospitalized patients with heart failure, and evaluate the prognostic value of baseline plasma NGAL for worsening renal function and death.Methods:Between March 2009 and June 2012, patients with HF as their primary diagnosis and 1-year follow up were recruited for analysis. NGAL, creatine, BUN and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were determined in all patients. Receiver operating characteristic (ROC), were performed to evaluate the association between biomarkers and death in every subgroups predefined.Results:We consecutively enrolled 396 patients hospitalized with HF and used CKD-EPI formula to calculate eGFR. All patients were divided into 2 groups:CRS group (n=97) and non- CRS group (n=299). In correlation analysis, r value between NGAL and NT-proBNP、creatine、BUN was 0.19、0.527、0.433 respectively (P< 0.001). NGAL was independently to evaluate worsening renal function the area under the curve (AUC) was 0.863.NGAL was independently associated with 1-year mortality in both categories of renal function, especially in CRS group. In receiver operating characteristic analyses, the area under the curve (AUC) for NGAL was 0.622 which was similar to that for NT-proBNP (0.674) when eGFR> 60 mL/min/1.73m2 (P=0.175), but lower when eGFR<60 mL/min/1.73m2 (0.467vs. 0.756, P< 0.001).Conclusions:Plasma NGAL was an independent worsening renal function predictor for hospitalized patients with heart failure, and can predict 1-year all-cause mortality in patients with heart failure.