Liver damage in patients hospitalized with acute decompensated heart failure, depending on the degree of glucose metabolism disorder

Aim. To study the frequency of cardiohepatic syndrome and steatosis by the value of controlled attenuation parameter (CAP), fibrosis, and their combination, depending on the degree of glucose metabolism disorder in patients with acute decompensated heart failure (ADHF).

Materials and methods. The study included 280 patients (53% men, average age 70.1 ± 10.8 years) with ADHF: 72.5% of patients had a history of arterial hypertension, 60% of patients had coronary heart disease. The HbA1c test was performed in all patients to assess the status of glucose metabolism. The patients were divided into groups depending on the results obtained: at HbA1c values < 5.7%, patients were included in the group without glucose metabolism disorders, at HbA1c 5.7–6.4% – in the prediabetes group, at HbA1c ≥ 6.5% – in the type 2 diabetes group. All patients underwent a standard physical examination at admission and at discharge. Clinical and comprehensive assessments of congestion were performed – NT-proBNP, lung ultrasound, liver fibroscan with CAP, and bioelectrical impedance analysis of body composition.

Results. The frequency of glucose metabolism disorders in patients hospitalized with ADHF was 57.5% (n = 161), while prediabetes was detected in 17.1% (n = 48) and type 2 diabetes – in 40.4% (n = 113) of patients. We revealed significantly higher incidence of steatosis by CAP value (69 vs. 42%, p < 0.001), fibrosis (80 vs. 64%, p < 0.001), and their combination (59 vs. 30%, p < 0.001), as well as cardiohepatic syndrome (87 vs. 61%, p < 0.001) in patients with ADHF and glucose metabolism disorders compared to individuals with ADHF without glucose metabolism disorders, respectively. The group of ADHF patients with glucose metabolism disorders and a combination of steatosis / fibrosis was characterized by more pronounced manifestations of metabolic syndrome, impaired kidney and liver function, and more pronounced manifestations (both clinical and laboratory) of congestion.

Conclusion. In patients with ADHF with glucose metabolism disorders, liver function test and liver fibroscan with CAP allow for identifying the most severe group of patients with a combination of steatosis/fibrosis and pronounced congestion.

1. Стаценко М.Е., Туркина С.В., Косивцова М.А. Особенности морфологии печени при неалкогольной ее болезни в зависимости от степени нарушений углеводного и липидного обмена у больных ИБС и сердечной недостаточностью. Экспериментальная и клиническая гастроэнтерология. 2017;138(2):38–44.

2. Younossi Z.M., Koenig A.B., Abdelatif D., Fazel Y., Henry L., Wymer M. Global epidemiology of nonalcoholic fatty liver disease-meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology. 2016;64(1):73–84. DOI: 10.1002/hep.28431.

3. Yang K.C., Hung H.F., Lu C.W., Chang H.H., Lee L.T., KuoChin Huang K.C. Association of non-alcoholic fatty liver disease with metabolic syndrome independently of central obesity and insulin resistance. Scientific Reports. 2016;6:27034. DOI: 10.1038/srep27034.

4. Стаценко М.Е., Туркина С.В., Шилина Н.Н. Поражение печени у больных с хронической сердечной недостаточностью ишемического генеза и сахарным диабетом типа 2 – коварный тандем: возможности дополнительной органопротективной терапии. Consilium Medicum. 2016;18(5):103–109.

5. Толкачева В.В., Диане М.Л., Хуцишвили Н.И., Кабельо Монтойа Ф.Э., Назаров И.С., Смирнов И.П. и др. Статус гидратации у пациентов, госпитализированных с декомпенсацией острой сердечной недостаточности, в зависимости от степени нарушения углеводного обмена. Бюллетень сибирской медицины. 2023;22(4):114–121. DOI: 10.20538/1682-0363-2023-4-114-121.

6. Vasconcelos L., Almeida E., Bachur L. Clinical evaluation and hepatic laboratory assessment in individuals with congestive heart failure. Arq. Bras. Cardiol. 2007;88(5):524–529. DOI: 10.1590/s0066-782x2007000500015.

7. Allen L., Felker G., Pocock S., McMurray J., Pfeffer M., Swedberg K. et al. Liver function abnormalities and outcome in patients with chronic heart failure: data from the Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity (CHARM) program. Eur. J. Heart Fail. 2009;11(2):170–177. DOI: 10.1093/eurjhf/hfn031.

8. Giallourakis C.C., Rosenberg P.M., Friedman L.S. The liver in heart failure. Clin. Liver Dis. 2002;6(4):947–967. DOI: 10.1016/s1089-3261(02)00056-9.

9. Bedogni G., Miglioli L., Masutti F., Tiribelli C., Marchesini G., Bellentani S. Prevalence of and risk factors for nonalcoholic fatty liver disease: The Dionysos nutrition and liver study. Hepatology. 2005;42(1):44–52. DOI: 10.1002/hep.20734.

10. Angulo P., Kleiner D., Dam-Larsen S., Adams L., Bjornsson E., Charatcharoenwitthaya P. et al. Liver fibrosis, but no other histologic features, is associated with long-term outcomes of patients with nonalcoholic fatty liver disease. Gastroenterology. 2015;149:389–397. DOI: 10.1053/j.gastro.2015.04.043.

11. Dulai P., Singh S., Patel J., Soni M., Prokop L., Younossi Z. et al. Increased risk of mortality by fibrosis stage in nonalcoholic fatty liver disease: systematic review and meta-analysis. Hepatology. 2017;65:1557–1565. DOI: 10.1002/hep.29085.

12. Ekstedt M., Hagström H., Nasr P., Fredrikson M., Stål P., Kechagias S. et al. Fibrosis stage is the strongest predictor for disease specific mortality in NAFLD after up to 33 years of follow-up. Hepatology. 2015;61:1547–1554. DOI: 10.1002/hep.27368.

13. Samsky M., Dunning A., DeVore A., Schulte P., Starling R., Tang W. et al. Liver function tests in patients with acute heart failure and associated outcomes: insights from ASCEND-HF: LFTs in AHF. Eur. J. Heart Fail. 2016;18(4):424–432. DOI: 10.1002/ejhf.440.

14. Poelzl G., Ess M., Mussner‐Seeber C., Pachinger O., Frick M., Ulmer H. Liver dysfunction in chronic heart failure: prevalence, characteristics and prognostic significance. Eur. J. Clin. Inv. 2012;42(2):153–163. DOI: 10.1111/j.13652362.2011.02573.x.

15. Chon Y.E., Kim K.J., Jung K.S., Kim S.U., Park J.Y., Kim D.Y. et al. The relationship between type 2 diabetes mellitus and non-alcoholic fatty liver disease measured by controlled attenuation parameter. Yonsei Med. J. 2016;57(4):885– 892. DOI: 10.3349/ymj.2016.57.4.885.

16. Ballestri S., Lonardo A., Romagnoli D., Carulli L., Losi L., Day C. et al. Ultrasonographic fatty liver indicator, a novel score which rules out NASH and is correlated with metabolic parameters in NAFLD. Liver International. 2012;32:1242– 1252. DOI: 10.1111/j.1478-3231.2012.02804.x.