Direct Bilirubin, but not Indirect Bilirubin, is Associated with Short-term Adverse Events in HFpEF

Sunying Wang; Yan Chen; Hanghao Ma; Yuwei Wang; Manqing Luo; Xianwei Xie; Qingyong Yang; Kaijin Lin; Meihua Lin; Lin Lin; Ping Chen; Qiaowen Zheng; Fuqing Sun

doi:10.2174/0115665232273115240102043640

Direct Bilirubin, but not Indirect Bilirubin, is Associated with Short-term Adverse Events in HFpEF

Curr Gene Ther. 2024 Jan 16. doi: 10.2174/0115665232273115240102043640. Online ahead of print.

Authors

Sunying Wang¹, Yan Chen², Hanghao Ma³, Yuwei Wang⁴, Manqing Luo⁵, Xianwei Xie⁶, Qingyong Yang⁷, Kaijin Lin¹, Meihua Lin¹, Lin Lin¹, Ping Chen¹, Qiaowen Zheng¹, Fuqing Sun¹

Affiliations

¹ Fuqing City Hospital Affiliated to Fujian Medical University, Fuqing, Fuzhou, China.
² Department of Ultrasound, Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.
³ Ningde People's Hospital, Ningde, China.
⁴ Department of Management, Fujian Yirong Information Technology Corporation, Fuzhou, China.
⁵ Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
⁶ Department of Cardiology, Fujian Provincial Hospital, Fuzhou, China.
⁷ Department of Internal Medicine, Jinshan Branch of Fujian Provincial Hospital, Fuzhou, China.

PMID: 38310459
DOI: 10.2174/0115665232273115240102043640

Abstract

Abnormal live function tests have been identified as independent risk factors for ominous prognosis in patients with heart failure. However, most of the previous studies have failed to determine the contribution of direct bilirubin (DBIL) and indirect bilirubin (IBIL) separately. Hence, we aimed to explore whether DBIL or IBIL is correlated with the prognosis of heart failure with preserved ejection fraction (HFpEF). <p> Methods: A total of 19837 patients were hospitalized for HFpEF between January 2012 and January 2022 in Fuqing City Hospital affiliated with Fujian Medical University. The primary endpoint was in-hospital all-cause mortality. Secondary endpoints included in-hospital cardiovascular mortality and 30-day re-admission for heart failure. <p> Results: Univariable analysis indicated that patients with elevated DBIL or IBIL were exposed to a higher risk of mortality and re-admission. However, in multivariable models, both ln-transformed DBIL and TBIL, but not IBIL, were independent risk factors for in-hospital all-cause mortality [hazard ratio (HR)=1.796, 95% confidential interval (CI)=1.477-2.183, P＜0.001; HR=1.854, 95% CI=1.461-2.352, P＜0.001; HR=1.161, 95% CI=0.959-1.407, P=0.126] and in-hospital cardiovascular mortality (HR=1.831, 95% CI=1.345-2.492, P＜0.001; HR=1.899, 95% CI=1.300-2.773, P=0.001; HR=1.145, 95% CI=0.841-1.561, P=0.389). Only DBIL remained independently associated with 30-day readmission for heart failure (HR=1.361, 95% CI=1.036-1.787, P=0.027). Adding ln-transformed DBIL to model 1 increased its discriminatory capacity (C-statistic: 0.851 to 0.869, respectively), whereas adding ln-transformed IBIL yielded little increment (C-statistic: 0.851 to 0.852, respectively). <p> Conclusion: DBIL, but not IBIL, was associated with short-term ominous prognosis in patients with HFpEF. Hence, DBIL may be the superior predictor for prognosis in HFpEF.

Keywords: Heart failure with preserved ejection fraction; direct bilirubin; indirect bilirubin; mortality; prognosis; readmission..