The structure of liver damage in patients with acute decompensated heart failure, the prognostic role of steatosis and liver density

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Funding Acknowledgements</jats:title> <jats:p>None.</jats:p> </jats:sec> <jats:sec> <jats:title>Aim</jats:title> <jats:p>To study the spectrum of liver damage in patients with acute decompensated heart failure (ADHF).</jats:p> </jats:sec> <jats:sec> <jats:title>Materials and methods</jats:title> <jats:p>Included were 566 patients hospitalized with ADHF, NYHA class II–IV, 66% men, mean age 72,4±11,4 years. All patients underwent laboratory and instrumental examination, the degree of steatosis and liver density were determined by transient elastometry methods, with an assessment of the controlled ultrasound attenuation parameter (CAP - Controlled Attenuation Parameter, S, dB/m) using a device according to standard methods. CAP values &lt;294 dB/m with steatosis degree 0 - S0, 295-309 dB/m - S1, 310-330 dB/m - S2, ≥331 dB/m - S3. Liver density was used: ≤5,8 kPa – normal liver density, ≥5,9 – stage F1, ≥7,2 kPa – F2, ≥9,5 kPa – F3, ≥12,5 kPa – F4. Laboratory manifestations of liver damage were considered to be increased aspartate aminotransferase, alanine aminotransferase, gamma-glutamyl transpeptidase and alkaline phosphatase.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The incidence of hepatic steatosis (≥S1) among patients with ADHF was 29%. Among patients with liver steatosis, minimal steatosis (S1) was detected in 19% of cases, moderate steatosis (S2) - 28,6%, severe steatosis S3 - 52,4%. In patients with steatosis, the frequency of laboratory indicators of liver damage was 53%, and in patients without steatosis - 49,2%. Liver density ≥ F1 was observed in 79,5% of patients. Stage F1 was diagnosed in 10,4% of cases, F2 - in 11%, F3 - 12,7%, F4 - 44,5%. However, no relationship was found between the severity of steatosis and liver density (p&gt;0,05). Multivariate Cox regression analysis showed that extremely low CAP values (&lt;234 dB/m) were associated with a worse prognosis and higher risk of HF mortality during the 3-year follow-up period (adjusted hazard ratio (aHR) 1,57 95% confidence interval (CI) 1,08–2,31, p=0,019) after adjustment for established risk factors and potential confounders. The presence of increased liver density &gt;15,9 kPa was also associated with a worse prognosis of the risk of death from HF during the 3-year follow-up period by Cox multivariate analysis (aHR 1,24, 95% CI 1,01–1,52, p= 0,040).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>Thus, extremely low CAP values (&lt;234 dB/m) and the presence of a marked increase in liver density (&gt;15,9 kPa) were associated with a worse prognosis in patients with ADHF during the 3-year follow-up period.</jats:p> </jats:sec>