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Significado clínico de las alteraciones en las pruebas de función hepática en la insuficiencia cardíaca descompensada;
Clinical Significance of Impaired Liver Function Tests in Decompensated Heart Failure

Creators:Fairman, Enrique, Mauro, Víctor M., Charask, Adrián A., Castillo Costa, Yanina B., Marrodán, Santiago E., Spampinato, Emiliano G., Raffaeli, Alesis, Bottini, Franco, Barrero, Carlos M.
2017-11-21

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Descripción

Introducción: Los progresos terapéuticos en la insuficiencia cardíaca crónica no se han reflejado en los pacientes descompensados por lo que nuevas herramientas terapéuticas pero también pronósticas son necesarias. Pese a formar parte de la rutina de ingreso el significado pronóstico del hepatograma no es claro Objetivo: Evaluar utilidad pronóstica del hepatograma en insuficiencia cardíaca descompensada. Materiales y Resultados:  En 700 pacientes con insuficiencia cardíaca, admitidos en forma consecutiva en dos unidades coronarias; hepatograma de ingreso disponible y sin alteración conocida de la función hepática,  se analizó prevalencia  y asociación con mortalidad hospitalaria de la elevación (al menos duplicación del valor normal) de la bilirrubina total (BT), la fosfatasa alcalina (FAL) y alanina aminotransferasa (ALT) o aspartato aminotransferasa (AST). 20,8% de los pacientes tuvieron alguna alteración del hepatograma, 6% presentaron aumento de BT, 12,6% de ALT o AST, y 12,6% de FAL. En el análisis univariado (OR; IC 95%)  alguna alteración del hepatograma 2,34 (1,18-4,65), BT 4,05 (1,66-9,83), ALT/AST 3,56 (1,72-7,34) pero no FAL se asociaron con mayor mortalidad hospitalaria.  En el modelo multivariado el shock cardiogénico 9,48 (2,31 - 38,78), BT 3,61 (1,29 - 10,04),   ALT o AST 2,83(1,28-6,25), insuficiencia renal al ingreso 3,55 (1,48 - 8,49) y el antecedente de EPOC 2,66 (1,21 - 5,87) se asociaron en forma independiente con mortalidad. Conclusión: Datos accesibles como el hepatograma aportan información pronóstica al ingreso. En una población no seleccionada de pacientes, es probable que la alteración del hepatograma exprese mayor vulnerabilidad que compromiso hemodinámico.

Background: Therapeutic progress in chronic heart failure has not been reflected in decompensated patients, compelling the need for new therapeutic and prognostic tools. Although liver function tests are part of routine admission studies, their clinical significance is not clearly established. Objective: The aim of this study was to evaluate the prognostic relevance of liver function tests in decompensated heart failure. Methods: The study analyzed the prevalence and in-hospital mortality association of elevated (at least twice the normal value) total bilirubin (TB), alkaline phosphatase (APh) and alanine aminotransferase (ALT) or aspartate aminotransferase (AST) in 700 consecutive patients admitted into two coronary care units due to decompensated heart failure, with liver function tests at admission, and no previous liver disease. Results: In 20.8% of cases, patients presented some abnormal liver function test: 6%, increased TB, 12.6% increased ALT or AST and 12.6% increased APh. In the univariate analysis [(OR (95% CI)], any abnormal liver function test [2.34 (1.18-4.65)], TB [4.05 (1.66-9.83)], ALT/AST [3.56 (1.72-7.34)] but not APh was associated with higher in-hospital mortality. In the multivariate model, cardiogenic shock [9.48 (2.31-38.78)], TB [3.61 (1.29-10.04)], AST/ALT [2.83 (1.28-6.25)], renal failure at admission [3.55 (1.48-8.49)] and history of chronic obstructive pulmonary disease [2.66 (1.21-5.87)] were independently associated with mortality. Conclusions: Accessible tests such as liver function assessment provide additional prognostic information at admission. In an unselected patient population, abnormal liver function may probably express increased vulnerability rather than hemodynamic impairment.

Metadatos destacados

Colecciones
Argentine Journal of Cardiology

Editor

Sociedad Argentina de Cardiología

Fuente

Revista Argentina de Cardiología; Vol 85, No 3 (2017); 216-222, Argentine Journal of Cardiology; Vol 85, No 3 (2017); 216-222

Citación

Fairman, Enrique et al., “Significado clínico de las alteraciones en las pruebas de función hepática en la insuficiencia cardíaca descompensada,” Archivo PPCT, consulta 2 de abril de 2026, http://archivoppct.caicyt.gov.ar/items/show/9324.

Dublin Core

Autor

Fairman, Enrique
Mauro, Víctor M.
Charask, Adrián A.
Castillo Costa, Yanina B.
Marrodán, Santiago E.
Spampinato, Emiliano G.
Raffaeli, Alesis
Bottini, Franco
Barrero, Carlos M.

Fuente

Revista Argentina de Cardiología; Vol 85, No 3 (2017); 216-222
Argentine Journal of Cardiology; Vol 85, No 3 (2017); 216-222

Editor

Sociedad Argentina de Cardiología

Fecha

2017-11-21

Derechos

Los que firman al pié, certificamos que tenemos total responsabilidad por la conducción de este estudio y por el diseño y la interpretación de los datos. Nosotros escribimos el manuscrito y somos responsables por la decisión acerca del mismo. Cada uno de nosotros cumple la definición de autor como se afirma en el Comité Internacional de Editores de Revistas Médicas (International Committee of Medical Journal Editors, ver www.icmje.org). Nosotros hemos visto y aprobado el manuscrito final. Ni el artículo, ni ninguna parte esencial del mismo, incluido las tablas y las figuras, será publicado o admitido para arbitrar a otra parte antes de aparecer en la Revista.También notificamos haber leído la sección “conflicto de intereses”, y revelaríamos cualquiera que existiera. Dejamos constancia que si nuestro artículo se publicara en la RAC, cederíamos los derechos (copyright) a la Revista.Los documentos publicados en esta revista están bajo la licencia Creative Commons Atribución-NoComercial-Compartir-Igual 2.5 Argentina.
Those signing below certify that we have full responsibility for the conduction of this study and for the design and interpretation of the information. We wrote the manuscript and are responsible for its decision. Each of us fulfills the definition of authorship as stated by the International Committee of Medical Journal Editors ( www.icmje.org). We have signed and approved the final manuscript. Neither the manuscript, nor any essential part thereof, including tables and figures, will be published or accepted for refereeing elsewhere before being published in the Journal. We have also read the "Conflict of Interest" section and would disclose any existing. We state that if our manuscript is published in the RAC, we shall transfer the copyright to the Journal.

Formato

Idioma

spa
eng

Tipo

info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion