Analysis Of Clinical Characteristics And Risk Factors Of Chronic Heart Failure Patients Complicated With Liver Function Injury

Objective: Patients with chronic heart failure are often accompanied by other organ dysfunction.Liver injury is one of them and can even affect the prognosis and outcome of patients with heart failure.The purpose of this study is to analyze the clinical characteristics of patients with chronic heart failure complicated with liver function injury and to explore the risk factors for the severity of liver function injury in patients with chronic heart failure,so as to further improve clinicians' understanding of cardiogenic liver injury.Methods:A total of 236 patients with chronic heart failure who met the inclusion and exclusion criteria in the Heart Center of the first Hospital of Lanzhou University from December 2016 to December 2019 were divided into three groups according to the Child-Pugh score of liver function incluing total bilirubin(TBIL),prothrombin time(PT),albumin,ascites volumn and the degree of hepatic encephalopathy.They were divided into grade A group(n = 133),grade B group(n = 74)and grade C group(n = 29).The clinical data of the first examination were collected by electronic medical record system.Laboratory tests included alanine aminotransferase(ALT),aspartate aminotransferase(AST),?-glutamyl transpeptidase(GGT),alkaline phosphatase(ALP),albumin,TBIL,PT and N-terminal pro-B-type natriuretic peptide(NT-proBNP).Echocardiographic parameters included left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),left atrial diameter(LAD),right ventricular end-diastolic diameter(RVEDD),right atrial transverse diameter(RATD)and pulmonary artery systolic pressure(PASP).The baseline data,laboratory examination and echocardiographic parameters of the three groups were compared.The correlation between Child-Pugh score of liver function andechocardiographic parameters,and the correlation between cholestatic enzymes and cardiac function indexes were analyzed.the clinical characteristics of patients with chronic heart failure complicated with liver function injury were summarized.The risk factors affecting the severity of liver function injury in patients with chronic heart failure were analyzed by ordered multivariate logistic regression model.Results:(1)There were no significant differences in age,sex,etiology,course of disease,body mass index(BMI),systolic blood pressure(SBP)and cardiac function grade of New York Heart Association(NYHA)among the three groups(P?0.05).(2)With the increase of Child-Pugh score of liver function,the LVEF decreased sequentially,while the levels of NT-proBNP,GGT,ALP,LVEDD,LAD,RVEDD,RATD and PASP increased sequentially.There were significant differences in NT-proBNP,GGT,ALP,LVEF,LVEDD,LAD,RVEDD,RATD and PASP among the three groups(P?0.05).The pairwise comparison between groups showed that the LVEF of grade C group was lower than the groups of grade A and grade B,and the LVEF of grade B group was lower than grade A group,NT-proBNP,GGT,ALP,LVEDD,LAD,RVEDD,RATD and PASP in grade C group were higher than those in grade A group,NT-proBNP,ALP,LVEDD,RVEDD,RATD and PASP in grade C group were higher than those in grade B group,and NT-proBNP,GGT,ALP,LAD,RVEDD,RATD and PASP in grade B group were higher than those in grade A group.(3)Correlation analysis showed that the Child-Pugh score was positively correlated with RVEDD,RATD,PASP,LVEDD and LAD,and negatively correlated with LVEF.The cholestasis indexes GGT and ALP were positively correlated with NT-proBNP and negatively correlated with LVEF(P?0.05).(4)Ordered multiple logistic regression analysis showed that RVEDD,RATD,LVEDD and PASP had significant effects on the severity of liver function injury in patients with chronic heart failure.The higher the values of RVEDD,RATD,LVEDD and PASP,the more severe the degree of liver function injury in patients with chronic heart failure.Conclusios:(1)The lower the LVEF of patients with chronic heart failure is,the higher the levels of NT-proBNP,RVEDD,RATD,LVEDD,LAD and PASP are,and the more serious the degree of liver function injury is.The liver function of patients with cardiogenic liver injury deteriorate with the aggravation of heart failure.(2)RVEDD,RATD,LVEDD and PASP were independent risk factors for the severity of liver function injury in patients with chronic heart failure.