Prognostic value of liver damage assessed through direct bilirubin levels and skeletal muscle weakness in patients with heart failure

Noda, Takumi; Kamiya, Kentaro; Hamazaki, Nobuaki; Nozaki, Kohei; Ichikawa, Takafumi; Yamashita, Masashi; Uchida, Shota; Maekawa, Emi; Terada, Tasuku; Reed, Jennifer L.; Yamaoka-Tojo, Minako; Matsunaga, Atsuhiko; Ako, Junya

Abstract

Background
Patients with heart failure (HF) often exhibit signs of liver dysfunction such as high bilirubin concentrations, leading to physical dysfunction and poor prognosis. Nevertheless, the relationship between direct bilirubin (DB), a fractionated form of total bilirubin, and dynapenia remains unclear, as does their effect on prognosis.

Objectives
This study investigated the association between DB concentrations and dynapenia in patients with HF.

Methods
This retrospective study included patients with HF who underwent assessments for DB concentration, and handgrip and leg strengths to evaluate dynapenia and muscle weakness, respectively. Multiple logistic regression analyses examined the associations of DB with muscle strength and dynapenia. Additionally, we examined the prognostic value of comorbid high DB concentrations (≥0.5 mg/dL) and dynapenia. The endpoint was all-cause mortality.

Results
Of 853 inpatients, high DB was identified in 147 and dynapenia in 377 (44.2%). Multiple regression analysis revealed that high DB was independently associated with decreased muscle strength (handgrip strength, P = 0.027; leg strength, P = 0.002). After adjusting for covariates, the high DB group (odds ratio: 1.800, 95% confidence interval [CI]: 1.203–2.695, P = 0.004) had a significantly higher risk of dynapenia than the low DB group. During the follow-up period, 189 patients died (median, 1.77 years; interquartile range, 0.64–3.81 years). The risk of death was significantly higher in the high DB and dynapenia group, even after adjusting for HF severity (hazard ratio: 2.610, 95% CI: 1.680–4.051, P<0.001).

Conclusions
High DB is associated with muscle weakness, and when combined with dynapenia, DB predicts a poorer prognosis in patients with HF.

Citation

Noda, T., Kamiya, K., Hamazaki, N., Nozaki, K., Ichikawa, T., Yamashita, M., Uchida, S., Maekawa, E., Terada, T., Reed, J. L., Yamaoka-Tojo, M., Matsunaga, A., & Ako, J. (2023). Prognostic value of liver damage assessed through direct bilirubin levels and skeletal muscle weakness in patients with heart failure. Heart and Lung, 60, 87-94. https://doi.org/10.1016/j.hrtlng.2023.03.001

• Journal Article Type: Article
• Acceptance Date: Mar 4, 2024
• Online Publication Date: Mar 17, 2023
• Publication Date: 2023-07
• Deposit Date: Nov 27, 2024
• Journal: Heart and Lung
• Print ISSN: 0147-9563
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 60
• Pages: 87-94
• DOI: https://doi.org/10.1016/j.hrtlng.2023.03.001
• Public URL: https://nottingham-repository.worktribe.com/output/40295250
• Publisher URL: https://www.heartandlung.org/article/S0147-9563(23)00066-3/fulltext