Should We Confine the Cardio Hepatic Syndrome Only in Congestive Cardiac Failure Patients?

AbstractIntroduction: Liver function abnormalities are not uncommon in patients with heart failure. Multiple reasons have been cited like impaired perfusion or elevated right-sided cardiac pressures, or are secondary to drug toxicity. In this study, we analyzed the patients admitted at our center to detect the profile of cardio-hepatic syndrome. This analysis may explore new etiologies for cardio-hepatic syndrome.Materials And Methods: This is an observational retrospective study done at our institute. We collected the liver function tests which were conducted in patients admitted in cardiology in 2015 (Jan to Dec at our center. Patients having abnormal liver function tests were analyzed for various etiologies. SGPT value > 45 Units per liter is considered as elevated.Results: Out of the patients admitted to cardiology department, SGPT and SGOT values are available in 2803 and 4577 patients respectively. Mean age of these patients was 58±12.9 yrs.In SGPT group 1881 were males. In 432(15.4%) patients SGPT was elevated. In them 326 (76%) were males. Among the patients in whom SGPT is elevated, also had elevated CPK and CPK-MB due to MI were in 154 patients (35.6%). In 24 patients (5.6%) SGPT was elevated along with NT pro BNP levels. Rest of the SGPT elevated patients (254 – 58.8%) does not come under CCF or MI category and out these patients about 146 patients were on either on statin or other drugs which can increase the liver enzymes. Still we require to evaluate the cause of hepatic abnormality in 106(24.5%) patients admitted with cardiac disease.Conclusions: Cardio-hepatic syndrome is not just confined to heart failure. Though heart failure, MI and drug induced hepatic dysfunction accounted for 75.5% of the etiology, we require to see present unknown the etiology for this sub group of cardio hepatic syndrome. Further elucidating the etiology for the remaining 24.5% cardio hepatic syndrome is of much interest.

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Abnormal Liver Function Tests and Long-Term Outcomes in Patients Discharged after Acute Heart Failure

Journal of Clinical Medicine ◽

10.3390/jcm10081730 ◽

2021 ◽

Vol 10 (8) ◽

pp. 1730

Author(s):

Hiroshi Miyama ◽

Yasuyuki Shiraishi ◽

Shun Kohsaka ◽

Ayumi Goda ◽

Yosuke Nishihata ◽

...

Keyword(s):

Heart Failure ◽

Liver Function ◽

Liver Function Tests ◽

Abnormal Liver Function ◽

Adverse Outcomes ◽

Long Term Outcomes ◽

Function Tests ◽

Parameter Values

Abnormal liver function tests (LFTs) are known to be associated with impaired clinical outcomes in heart failure (HF) patients. However, this implication varies with each single LFT panel. We aim to evaluate the long-term outcomes of acute HF (AHF) patients by assessing multiple LFT panels in combination. From a prospective multicenter registry in Japan, 1158 AHF patients who were successfully discharged were analyzed (mean age, 73.9 ± 13.5 years; men, 58%). LFTs (i.e., total bilirubin, aspartate aminotransferase or alanine aminotransferase, and alkaline phosphatase) at discharge were assessed; borderline and abnormal LFTs were defined as 1 and ≥2 parameter values above the normal range, respectively. The primary endpoint was composite of all-cause death or HF readmission. At the time of discharge, 28.7% and 8.6% of patients showed borderline and abnormal LFTs, respectively. There were 196 (16.9%) deaths and 298 (25.7%) HF readmissions during a median 12.4-month follow-up period. The abnormal LFTs group had a significantly higher risk of experiencing the composite outcome (adjusted hazard ratio: 1.51, 95% confidence interval: 1.08–2.12, p = 0.017), whereas the borderline LFTs group was not associated with higher risk of adverse events when referenced to the normal LFTs group. Among AHF patients, the combined elevation of ≥2 LFT panels at discharge was associated with long-term adverse outcomes.

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Abnormal liver function tests in acute heart failure: relationship with clinical characteristics and outcome in the PROTECT study

European Journal of Heart Failure ◽

10.1002/ejhf.532 ◽

2016 ◽

Vol 18 (7) ◽

pp. 830-839 ◽

Cited By ~ 33

Author(s):

Jan Biegus ◽

Hans L. Hillege ◽

Douwe Postmus ◽

Mattia. A.E. Valente ◽

Daniel M. Bloomfield ◽

...

Keyword(s):

Heart Failure ◽

Liver Function ◽

Acute Heart Failure ◽

Clinical Characteristics ◽

Liver Function Tests ◽

Abnormal Liver Function ◽

Function Tests ◽

Protect Study

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Clinical profile of patients of pyrexia with hepatic dysfunction in a tertiary care hospital in Southern Rajasthan region of India

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20204905 ◽

2020 ◽

Vol 8 (11) ◽

pp. 4066

Author(s):

Abhishek Mistry ◽

Yogesh Kumar Singhal ◽

Pankaj Gupta ◽

D. C. Kumawat

Keyword(s):

Liver Function ◽

Hepatic Dysfunction ◽

Demographic Data ◽

Tertiary Care ◽

Liver Function Tests ◽

Abnormal Liver Function ◽

Care Hospital ◽

General Physical Examination ◽

Function Tests ◽

General Physical

Background: Pyrexia in association with hepatic dysfunction is commonly found in clinical practice with varied etiologies like malaria, dengue, typhoid, scrub typhus, viral hepatitis, etc. The liver is frequently involved in systemic infections, resulting in various types of abnormal liver function tests. It is very important to know the frequency and pattern of abnormal liver function tests in each infection for its appropriate management.Methods: A complete data of all the patients admitted in medicine wards and medicine ICU from January to December 2018 were studied. One hundred and ten patients with fever with abnormal liver function tests were interviewed and presenting complaints were noted. Demographic data such as age and sex were noted. These patients underwent a thorough general physical examination and systemic examination. The findings were noted on a predesigned and pretested proforma. The selected patient underwent blood investigations related to liver functions.Results: Most of the patients were of age group of 21 to 50 years (65 patients), 67 patients (60.91%) were males and 43 (39.09%) were females. Malaria (25.45%) and dengue (26.36%) were major etiologies. Hepatomegaly (46.36%), icterus in (45.45%) and splenomegaly (42.73%) were most common clinical signs.Conclusions: Present study will help clinicians to identify etiological factors and clinical picture in patients of pyrexia with hepatic dysfunction.

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Drug-induced hepatotoxicity: incidence of abnormal liver function tests consistent with volatile anaesthetic hepatitis in trauma patients

Liver International ◽

10.1111/liv.12278 ◽

2013 ◽

Vol 34 (4) ◽

pp. 576-582 ◽

Cited By ~ 15

Author(s):

Jonathan Lin ◽

David Moore ◽

Brad Hockey ◽

Rachel Di Lernia ◽

Alexandra Gorelik ◽

...

Keyword(s):

Liver Function ◽

Liver Function Tests ◽

Abnormal Liver Function ◽

Volatile Anaesthetic ◽

Trauma Patients ◽

Drug Induced ◽

Function Tests

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Association of Abnormal Liver Function Tests to Outcomes in Patients with a New Diagnosis of Heart Failure with Reduced Ejection Fraction in the Outpatient Clinic

Journal of Cardiovascular Diseases & Diagnosis ◽

10.4172/2329-9517.1000300 ◽

2017 ◽

Vol 05 (06) ◽

Author(s):

Koganti S ◽

Dasgupta S ◽

Crossman R ◽

Banerjee P

Keyword(s):

Heart Failure ◽

Liver Function ◽

Ejection Fraction ◽

Outpatient Clinic ◽

Liver Function Tests ◽

Abnormal Liver Function ◽

Reduced Ejection Fraction ◽

Function Tests ◽

New Diagnosis

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Longitudinal Trends, Hemodynamic Profiles, and Prognostic Value of Abnormal Liver Function Tests in Patients With Acute Decompensated Heart Failure: An Analysis of the ESCAPE Trial

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2014.05.001 ◽

2014 ◽

Vol 20 (7) ◽

pp. 476-484 ◽

Cited By ~ 15

Author(s):

Michael Scholfield ◽

Matthew B. Schabath ◽

Maya Guglin

Keyword(s):

Heart Failure ◽

Liver Function ◽

Prognostic Value ◽

Acute Decompensated Heart Failure ◽

Decompensated Heart Failure ◽

Liver Function Tests ◽

Abnormal Liver Function ◽

Escape Trial ◽

Function Tests

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Prognostic Significance of Abnormal Liver Function Tests in Acute Decompensated Heart Failure

Gastroenterology ◽

10.1016/s0016-5085(11)61876-3 ◽

2011 ◽

Vol 140 (5) ◽

pp. S-457

Author(s):

JayaKrishna Chintanaboina ◽

Matthew S. Haner ◽

Arjinder Sethi ◽

Nimesh Patel ◽

Walid Tanyous ◽

...

Keyword(s):

Heart Failure ◽

Liver Function ◽

Acute Decompensated Heart Failure ◽

Prognostic Significance ◽

Decompensated Heart Failure ◽

Liver Function Tests ◽

Abnormal Liver Function ◽

Function Tests

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Cytomegalovirus may mimic the presentation of intrahepatic cholestasis and hemolysis, elevated liver enzymes and low platelets in immunosuppressed pregnant women

Obstetric Medicine ◽

10.1177/1753495x16641807 ◽

2016 ◽

Vol 9 (3) ◽

pp. 135-137 ◽

Cited By ~ 1

Author(s):

Gurleen Wander ◽

Francesa Neuberger ◽

Mandish K Dhanjal ◽

Catherine Nelson-Piercy ◽

May Ching Soh

Keyword(s):

Liver Function ◽

Pregnant Women ◽

Intrahepatic Cholestasis ◽

Congenital Abnormalities ◽

Liver Enzymes ◽

Liver Function Tests ◽

Abnormal Liver Function ◽

Function Tests ◽

Elevated Liver Enzymes ◽

Cholestasis Of Pregnancy

Most published cases of cytomegalovirus infection in pregnancy relate to congenital abnormalities in neonates infected in early pregnancy, while the mother remains asymptomatic. We describe a diagnostically challenging case of an immunosuppressed woman with scleroderma who developed deranged liver function tests attributed to intrahepatic cholestasis of pregnancy and haemolysis, elevated liver enzymes and low platelets syndrome but was ultimately found to have disseminated cytomegalovirus. Cytomegalovirus can present in a myriad of ways. Clinicians caring for immunocompromised pregnant women should consider cytomegalovirus as a possible differential diagnosis when reviewing abnormal liver function tests.

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