Elevated levels of vitamin B12 in chronic stable heart failure: a marker for subclinical liver damage and impaired prognosis

Background: Elevated vitamin B12 is a sign for liver damage, but its significance in chronic stable heart failure (HF) is less known. The present study investigated the clinical correlates and prognostic significance of vitamin B12 levels in stable systolic HF. Methods: A total of 129 consecutive patients with HF and 50 control subjects were enrolled. Data regarding demographics, clinical signs, therapeutic and conventional echocardiographic measurements were recorded for all patients. Right-sided HF was defined as the presence of at least one of the typical symptoms (ankle swelling) or specific signs (jugular venous distention or abdominojugular reflux) of right HF. Cox proportional hazards regression analyses were performed to determine the independent prognostic determinants of mortality. Results: Baseline B12 levels in HF patients (n=129) with and without right sided HF were significantly higher compared to healthy controls (n=50): Median 311 pg/mL and 235 pg/mL vs 198 pg/mL, respectively (P=0.005). Folic acid levels were similar between the study groups. Age, ejection fraction, left atrial size, estimated glomerular filtration rate, and direct and indirect bilirubin levels were significantly correlated to serum B12 level in univariate analysis. In multivariate analysis, independent correlates of B12 were direct bilirubin (R=0.51, P<0.001) and age (R=0.19, P=0.028). Patients with HF were followed-up for a median period of 32 months. Median B12 levels were significantly higher in patients who subsequently died (n=35) compared to survivors, but folic acid was not different between the two groups. ROC analysis showed that B12 values >= 270 pg/mL had 80% sensitivity and 58% specificity for predicting all-cause mortality (area under the curve=0.672, 95% CI=0.562-0.781; P=0.003). However, in Cox regression analysis, only left atrial diameter, level of direct bilirubin, and the presence of abdominojugular reflux were independent predictors of death. Conclusion: Increased B12 in stable HF patients is associated with increased direct bilirubin due to right HF, indicating a cardiohepatic syndrome, but neither B12 nor folic acid are independently associated with mortality.

Yazar Argan, Onur
Ural, Dilek
Karauzum, Kurtulus
Bozyel, Serdar
Aktas, Mujdat
Karauzum, Irem Yilmaz
Kozdag, Guliz
Yayın Türü Article
Tek Biçim Adres https://hdl.handle.net/20.500.12628/2536
Tek Biçim Adres 10.2147/TCRM.S164200
Konu Başlıkları heart failure
vitamin B12
bilirubin
prognosis
Koleksiyonlar Araştırma Çıktıları | WoS | Scopus | TR-Dizin | PubMed | SOBİAD
PubMed İndeksli Yayınlar Koleksiyonu
WoS İndeksli Yayınlar Koleksiyonu
Dergi Adı THERAPEUTICS AND CLINICAL RISK MANAGEMENT
Dergi Cilt Bilgisi 14
Sayfalar 1067 - 1073
Yayın Yılı 2018
Eser Adı
[dc.title]
Elevated levels of vitamin B12 in chronic stable heart failure: a marker for subclinical liver damage and impaired prognosis
Yazar
[dc.contributor.author]
Argan, Onur
Yazar
[dc.contributor.author]
Ural, Dilek
Yazar
[dc.contributor.author]
Karauzum, Kurtulus
Yazar
[dc.contributor.author]
Bozyel, Serdar
Yazar
[dc.contributor.author]
Aktas, Mujdat
Yazar
[dc.contributor.author]
Karauzum, Irem Yilmaz
Yazar
[dc.contributor.author]
Kozdag, Guliz
Yayın Yılı
[dc.date.issued]
2018
Yayıncı
[dc.publisher]
DOVE MEDICAL PRESS LTD
Yayın Türü
[dc.type]
article
Özet
[dc.description.abstract]
Background: Elevated vitamin B12 is a sign for liver damage, but its significance in chronic stable heart failure (HF) is less known. The present study investigated the clinical correlates and prognostic significance of vitamin B12 levels in stable systolic HF. Methods: A total of 129 consecutive patients with HF and 50 control subjects were enrolled. Data regarding demographics, clinical signs, therapeutic and conventional echocardiographic measurements were recorded for all patients. Right-sided HF was defined as the presence of at least one of the typical symptoms (ankle swelling) or specific signs (jugular venous distention or abdominojugular reflux) of right HF. Cox proportional hazards regression analyses were performed to determine the independent prognostic determinants of mortality. Results: Baseline B12 levels in HF patients (n=129) with and without right sided HF were significantly higher compared to healthy controls (n=50): Median 311 pg/mL and 235 pg/mL vs 198 pg/mL, respectively (P=0.005). Folic acid levels were similar between the study groups. Age, ejection fraction, left atrial size, estimated glomerular filtration rate, and direct and indirect bilirubin levels were significantly correlated to serum B12 level in univariate analysis. In multivariate analysis, independent correlates of B12 were direct bilirubin (R=0.51, P<0.001) and age (R=0.19, P=0.028). Patients with HF were followed-up for a median period of 32 months. Median B12 levels were significantly higher in patients who subsequently died (n=35) compared to survivors, but folic acid was not different between the two groups. ROC analysis showed that B12 values >= 270 pg/mL had 80% sensitivity and 58% specificity for predicting all-cause mortality (area under the curve=0.672, 95% CI=0.562-0.781; P=0.003). However, in Cox regression analysis, only left atrial diameter, level of direct bilirubin, and the presence of abdominojugular reflux were independent predictors of death. Conclusion: Increased B12 in stable HF patients is associated with increased direct bilirubin due to right HF, indicating a cardiohepatic syndrome, but neither B12 nor folic acid are independently associated with mortality.
Açıklama
[dc.description]
WOS: 000434357200002
Açıklama
[dc.description]
PubMed: 29922067
Kayıt Giriş Tarihi
[dc.date.accessioned]
2019-12-23
Açık Erişim Tarihi
[dc.date.available]
2019-12-23
Yayın Dili
[dc.language.iso]
eng
Konu Başlıkları
[dc.subject]
heart failure
Konu Başlıkları
[dc.subject]
vitamin B12
Konu Başlıkları
[dc.subject]
bilirubin
Konu Başlıkları
[dc.subject]
prognosis
Haklar
[dc.rights]
info:eu-repo/semantics/openAccess
ISSN
[dc.identifier.issn]
1178-203X
İlk Sayfa Sayısı
[dc.identifier.startpage]
1067
Son Sayfa Sayısı
[dc.identifier.endpage]
1073
Dergi Adı
[dc.relation.journal]
THERAPEUTICS AND CLINICAL RISK MANAGEMENT
Dergi Cilt Bilgisi
[dc.identifier.volume]
14
Tek Biçim Adres
[dc.identifier.uri]
https://dx.doi.org/10.2147/TCRM.S164200
Tek Biçim Adres
[dc.identifier.uri]
https://hdl.handle.net/20.500.12628/2536
Görüntülenme Sayısı ( Şehir )
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Görüntülenme Sayısı ( Zaman Dağılımı )
Görüntülenme
168
09.12.2022 tarihinden bu yana
İndirme
1
09.12.2022 tarihinden bu yana
Son Erişim Tarihi
14 Temmuz 2024 13:18
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levels patients direct analysis bilirubin independent mortality stable significantly compared abdominojugular presence Median regression higher correlates between atrial vitamin significance groups associated clinical prognostic period median months Background followed-up Patients multivariate univariate correlated indirect subsequently
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