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Significado clínico de las alteraciones en las pruebas de función hepática en la insuficiencia cardíaca descompensada

2017; Sociedad Argentina de Cardiología; Volume: 85; Issue: 3 Linguagem: Espanhol

1850-3748

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

Potassium and Related Disorders

espanolIntroduccion: Los progresos terapeuticos en la insuficiencia cardiaca cronica no se han reflejado en los pacientes descompensados por lo que nuevas herramientas terapeuticas pero tambien pronosticas son necesarias. Pese a formar parte de la rutina de ingreso el significado pronostico del hepatograma no es claro Objetivo: Evaluar utilidad pronostica del hepatograma en insuficiencia cardiaca descompensada. Materiales y Resultados: En 700 pacientes con insuficiencia cardiaca, admitidos en forma consecutiva en dos unidades coronarias; hepatograma de ingreso disponible y sin alteracion conocida de la funcion hepatica, se analizo prevalencia y asociacion con mortalidad hospitalaria de la elevacion (al menos duplicacion 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 alteracion del hepatograma, 6% presentaron aumento de BT, 12,6% de ALT o AST, y 12,6% de FAL. En el analisis univariado (OR; IC 95%) alguna alteracion 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 cardiogenico 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. Conclusion: Datos accesibles como el hepatograma aportan informacion pronostica al ingreso. En una poblacion no seleccionada de pacientes, es probable que la alteracion del hepatograma exprese mayor vulnerabilidad que compromiso hemodinamico. EnglishBackground: 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.