[The impact of serum total bilirubin level on long-term prognosis in patients with chronic heart failure].

OBJECTIVE: To analyze the relationship between serum total bilirubin coincident with congestive heart failure (CHF) exacerbation and subsequent long-term mortality in patients with CHF. METHODS: The study population consisted of 140 consecutive patients admitted for CHF exacerbation with left ventricular ejection fraction ≤ 45%. They were divided into 2 groups according to whether death attacked or not in the following 28.5 months. Binary logistic regression analysis was used to investigate independent predictors of death from clinical parameters on admission or within 24 hours. RESULTS: Serum TBil and B-type natriuretic peptide (BNP) levels on admission were independent predictors of subsequent death after hospital discharge. According to increasing textiles of TBil stratified by the level of 12.8 and 18.2 mmol/L, the patients were divided into 3 groups: lower-level group (TBil ≤ 12.8 mmol/L), moderate-level group(TBil > 12.8 ∼ 18.2 mmol/L) and higher-level group (TBil > 18.2 mmol/L), with the death rates after 28.5 months of 12.2%, 17.9% and 38.9%, respectively(P = 0.002). Meanwhile, the pulse pressure decreased to (55.5 ± 17.3) mm Hg (1 mm Hg = 0.133 kPa), (48.9 ± 13.1) mm Hg and (46.1 ± 13.7) mm Hg, respectively (P = 0.008). TBil on admission had significant correlation with echocardiography-measured left ventricular endo-diastolic diameter (r = 0.34, P = 0.000) and right ventricular diastolic diameter (r = 0.23, P = 0.011). CONCLUSIONS: Increased TBil coincident with cardiac decompensation predicts a worse long-term death of CHF, presumably through the potential liability to both decompensated RV function and lower cardiac output syndrome occurred simultaneously when HF deteriorates.