TY - JOUR
T1 - Prognostic value of prothrombin time international normalized ratio in acute decompensated heart failure - A combined marker of hepatic insufficiency and hemostatic abnormality
AU - Okada, Atsushi
AU - Sugano, Yasuo
AU - Nagai, Toshiyuki
AU - Takashio, Seiji
AU - Honda, Satoshi
AU - Asaumi, Yasuhide
AU - Aiba, Takeshi
AU - Noguchi, Teruo
AU - Kusano, Kengo F.
AU - Ogawa, Hisao
AU - Yasuda, Satoshi
AU - Anzai, Toshihisa
N1 - Publisher Copyright:
© 2016, Japanese Circulation Society. All rights reserved.
PY - 2016/3/25
Y1 - 2016/3/25
N2 - Background: There are limited studies regarding the prognostic value of coagulation abnormalities in heart failure patients. The clinical significance of prothrombin time international normalized ratio (INR), a widely accepted marker assessing coagulation abnormalities, in acute decompensated heart failure (ADHF) remains unclear. Methods and Results: Among 561 consecutive patients admitted for ADHF, INR was assessed in 294 patients without prior anticoagulation therapy, acute coronary syndrome, liver disease, or overt disseminated intravascular coagulation. Increased INR on admission was positively associated with increased levels of thrombin-antithrombin complex, C-reactive protein, total bilirubin, γ-glutamyl transpeptidase, inferior vena cava diameter, tricuspid regurgitation severity, markers of neurohormonal activation, and also negatively associated with decreased albumin, cholinesterase, and total cholesterol. In contrast, there was no significant association with left ventricular ejection fraction, serum sodium or blood urea nitrogen. Multivariate analysis showed that increased INR was independently associated with increased all-cause mortality (hazard ratio 1.89 per 0.1 increase, 95% confidence interval 1.14–3.13, P=0.013) during the median follow up of 284 days. Increased INR also had a higher prognostic value compared to risk score models including the Model for End-Stage Liver Disease (MELD) score or the MELD excluding INR (MELD-XI) score. Conclusions: Increased INR is an independent predictor of all-cause mortality in ADHF patients without anticoagulation, reflecting coagulation abnormalities and hepatic insufficiency, possibly through systemic inflammation, neurohormonal activation and venous congestion.
AB - Background: There are limited studies regarding the prognostic value of coagulation abnormalities in heart failure patients. The clinical significance of prothrombin time international normalized ratio (INR), a widely accepted marker assessing coagulation abnormalities, in acute decompensated heart failure (ADHF) remains unclear. Methods and Results: Among 561 consecutive patients admitted for ADHF, INR was assessed in 294 patients without prior anticoagulation therapy, acute coronary syndrome, liver disease, or overt disseminated intravascular coagulation. Increased INR on admission was positively associated with increased levels of thrombin-antithrombin complex, C-reactive protein, total bilirubin, γ-glutamyl transpeptidase, inferior vena cava diameter, tricuspid regurgitation severity, markers of neurohormonal activation, and also negatively associated with decreased albumin, cholinesterase, and total cholesterol. In contrast, there was no significant association with left ventricular ejection fraction, serum sodium or blood urea nitrogen. Multivariate analysis showed that increased INR was independently associated with increased all-cause mortality (hazard ratio 1.89 per 0.1 increase, 95% confidence interval 1.14–3.13, P=0.013) during the median follow up of 284 days. Increased INR also had a higher prognostic value compared to risk score models including the Model for End-Stage Liver Disease (MELD) score or the MELD excluding INR (MELD-XI) score. Conclusions: Increased INR is an independent predictor of all-cause mortality in ADHF patients without anticoagulation, reflecting coagulation abnormalities and hepatic insufficiency, possibly through systemic inflammation, neurohormonal activation and venous congestion.
KW - Acute decompensated heart failure
KW - Coagulation
KW - Inflammation
KW - Liver
KW - Prognosis
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U2 - 10.1253/circj.CJ-15-1326
DO - 10.1253/circj.CJ-15-1326
M3 - Article
C2 - 26924077
AN - SCOPUS:84961644472
SN - 1346-9843
VL - 80
SP - 913
EP - 923
JO - Circulation Journal
JF - Circulation Journal
IS - 4
ER -