Direct bilirubin: A new risk factor of adverse outcome in idiopathic pulmonary arterial hypertension
Direct bilirubin: A new risk factor of adverse outcome in idiopathic pulmonary arterial hypertension
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DOI：
10.1016/j.ijcard.2016.11.036
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发表时间：
2017-02-01
影响因子：
3.5
通讯作者：
Jing, Zhi-Cheng
中科院分区：
文献类型：
--
作者：
Xu, Xi-Qi;Lv, Zi-Chao;Jing, Zhi-Cheng
背景资料：以往的研究表明，总胆红素升高与晚期心力衰竭有关，但没有研究确定直接血清胆红素（DBIL）在特发性肺动脉高压（IPAH）中的预测价值。本研究旨在探讨基线和后续DBIL IPAH.Methods患者的预测价值：血清DBIL测定404 IPAH患者在登记。约92%的患者在确诊后接受了特异性药物治疗。在平均8.3个月的治疗后，在237例患者中重复了血清DBIL。采用Kaplan-Meier法比较DBIL正常组和DBIL异常组的生存率。结果：在中位随访期40个月内，153例患者死亡。与存活者相比，非存活者的基线DBIL水平显著更高（p < 0.001）。PAH治疗期间，存活者的DBIL水平显著降低，而非存活者几乎没有降低。根据Kaplan-Meier生存分析，基线或治疗期间DBIL异常的患者的生存率显著低于DBIL正常组（分别为p - 0.002和p < 0.0001）。根据多因素分析，基线DBIL是IPAH死亡率的独立危险因素。结论：血清DBIL可以预测IPAH的严重程度和结果：特别是，在PAH特异性药物治疗期间DBIL没有明显下降与IPAH预后不良密切相关。(C)2016爱思唯尔爱尔兰有限公司版权所有。
Background: Previous studies have shown that elevated total bilirubin was associated with advanced heart failure, yet no study has ascertained the predictive value of direct serum bilirubin (DBIL) in idiopathic pulmonary arterial hypertension (IPAH). This study aimed to investigate the predictive value of both baseline and follow-up DBIL in patients with IPAH.Methods: Serum DBIL was measured in 404 IPAH patients at enrollment. Almost 92% patients received specific drugs after diagnosis confirmed. Serum DBIL was repeated in 237 patients after a mean of 8.3 months treatment. Survival rate among normal DBIL group and abnormal DBIL group was compared using the Kaplan-Meier method. The prognostic value of baseline variables was tested by Cox regression models.Results: During median follow-up period of 40 months, 153 patients died. Baseline DBIL levels were significantly higher in non-survivors compared with survivors (p < 0.001). DBIL levels in survivors decreased significantly during PAH therapy, whereas there was almost no decrease in non-survivors. Patients with abnormal DBIL at baseline or during therapy had a significantly lower survival rates than those with normal DBIL group, according to Kaplan-Meier survival analysis (p - 0.002 and p < 0.0001, respectively). According to multivariate analyses, baseline DBIL was an independent risk factor of mortality in IPAH.Conclusions: Serum DBIL could predict severity and outcomes of IPAH: in particular, no obvious decrease in DBIL during PAH-specific drug therapy is strongly associated with worse prognosis in IPAH. (C) 2016 Elsevier Ireland Ltd. All rights reserved.