Prognostic value of cardio-hepatic-skeletal muscle syndrome in patients with heart failure.

Affiliation

Noda T(1), Kamiya K(2)(3), Hamazaki N(4), Nozaki K(4), Ichikawa T(4), Nakamura T(1), Yamashita M(1), Uchida S(1), Maekawa E(5), Reed JL(6)(7)(8), Yamaoka-Tojo M(1)(9), Matsunaga A(1)(9), Ako J(5).
Author information:
(1)Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan.
(2)Department of Rehabilitation Sciences, Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan. [Email]
(3)Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan. [Email]
(4)Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan.
(5)Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
(6)Exercise Physiology and Cardiovascular Health Lab, Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada.
(7)Faculty of Medicine, University of Ottawa, Ottawa, Canada.
(8)School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.
(9)Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan.

Abstract

Although heart failure (HF) and liver dysfunction often coexist because of complex cardiohepatic interactions, the association between liver dysfunction and physical dysfunction, and between coexistence of both and prognosis in HF patients remains unclear. We reviewed 895 patients with HF (mean age, 69.4 ± 14.2 years) who underwent liver function test using model for end-stage liver disease excluding international normalized ratio (MELD-XI) score and physical function test (grip strength, leg strength, gait speed, and 6-min walking distance [6MWD]). In the multiple regression analysis, MELD-XI score was independently associated with lower grip strength, leg strength, gait speed, and 6MWD (all P < 0.001). One hundred thirty deaths occurred over a median follow-up period of 1.67 years (interquartile range: 0.62-3.04). For all-cause mortality, patients with high MELD-XI scores and reduced physical functions were found to have a significantly higher mortality risk even after adjusting for several covariates (grip strength, hazard ratio [HR]: 3.80, P < 0.001; leg strength, HR: 4.65, P < 0.001; gait speed, HR: 2.49, P = 0.001, and 6MWD, HR: 5.48, P < 0.001). Liver dysfunction was correlated with reduced physical function. Moreover, the coexistence of lower physical function and liver dysfunction considerably affected prognosis in patients with HF.