Prevalence and clinical correlates of liver function test abnormalities in acute heart failure

In Africa, heart failure is an important cause of death. In acute heart failure (AHF) liver function test (LFT) abnormalities have been shown to be widespread in the industrialized nations and to be somewhat linked to adverse outcomes. However, there is sparse information regarding abnormalities of LFT in AHF within Africa, particularly in the West-African sub-region, which includes Nigeria, the continents most populated nation. This study sought to determine the prevalence and clinical associations of abnormalities of LFT among Nigerian patients hospitalized with AHF. In a prospective study we enrolled 100 volunteers, 50 of them were admitted AHF patients, and 50 were sex and age matched healthy controls. Participants were recruited consecutively after giving informed consent. All underwent laboratory blood testing for six LFT parameters - alkaline phosphatase (ALP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), albumin, and total bilirubin – and echocardiographic assessment. Those with pre-existing liver disease were excluded. Associations between LFT abnormalities, clinical, and echocardiographic parameters were analyzed. All AHF patients demonstrated at least one LFT abnormality (100%). Hypoalbuminemia (78%) and elevated GGT (74%) were most common [others: elevated ALP-10%, elevated ALT-18%, elevated AST-60%, and elevated total bilirubin-22%]. There was significant negative correlation between ALT, AST, ALP, Total bilirubin, and blood pressure (both systolic and diastolic). Low systolic blood pressure (BP) was associated with elevated ALT and ALP; both p = 0.003. Low diastolic blood pressure was associated with elevated ALT, AST (transaminases), and total bilirubin; p < 0.001, p = 0.002, and p = 0.006, respectively. Ankle edema was associated with elevated GGT; p = 0.007. Ascites was associated with hypoalbuminemia; p = 0.002. High right atrial pressure was associated with elevated GGT and hypoalbuminemia; p = 0.008 and p = 0.042, respectively. Heart failure with reduced ejection fraction (HFrEF) was associated with elevated total bilirubin; p = 0.043. E/e’ >14 and grade III LV diastolic dysfunction were associated with hypoalbuminemia; both p = 0.004. LFT abnormalities were universal among Nigerian patients with AHF, and associated with distinct pathophysiological mechanisms: hypoperfusion (elevated transaminases and bilirubin), systemic congestion (elevated GGT, hypoalbuminemia), and left ventricular dysfunction (elevated bilirubin in systolic dysfunction, hypoalbuminemia in diastolic dysfunction). Routine LFT assessment may provide inexpensive, clinically useful insights that may guide therapy in AHF, particularly in resource-limited settings.