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  • Use and diagnostic value of liver enzyme tests in the emergency department and subsequent heart failure diagnosis: a retrospective cohort study

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Emergency medicine
Original research
Use and diagnostic value of liver enzyme tests in the emergency department and subsequent heart failure diagnosis: a retrospective cohort study
  1. Elena Vasti1,
  2. Jeffrey A Tabas2,
  3. Ari Hoffman3,
  4. Mark Pletcher4,5
  1. 1Department of Medicine, Stanford Health Care, Stockton, California, USA
  2. 2Department of Hospital Medicine, University of California San Francisco, San Francisco, California, USA
  3. 3University of California San Francisco, San Francisco, California, USA
  4. 4Department of Internal Medicine, University of California San Francisco, San Francisco, California, USA
  5. 5Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, California, USA
  1. Correspondence to Dr Elena Vasti; ecvasti{at}gmail.com

Abstract

Objectives To determine (1) if liver function tests (LFTs) are ordered in the emergency department (ED) in patients with suspected acute decompensated heart failure (ADHF) and (2) if the pattern of LFT abnormalities are meaningfully associated with a discharge diagnosis of ADHF among patients for whom these tests were ordered.

Setting We conducted a single-centre retrospective cohort study of patients with suspected ADHF who were seen in an academic tertiary ED using electronic medical records.

Participants All ED patients admitted with suspected ADHF from January 2017 to May 2018, defined as any patient who had a brain natriuretic peptide (BNP) ordered.

Primary outcome The primary outcome was ADHF diagnosis at discharge.

Results In 5323 ED patients with suspected ADHF, 60% (n=3184) had LFTs ordered; 34.6% were abnormal. Men comprised 56% of patients with abnormal LFTs and the average age was 67 years. The odds of a final diagnosis of ADHF in the univariate analysis was 59% higher in patients with abnormal LFTs (OR=1.59, (95% CI 1.35 to 1.87) p<0.001) and remained significant though attenuated after adjusting for BNP, race and ethnicity and age (ORadj=1.31 (95% CI 1.09 to 1.57), p=0.004). Likelihood ratios for abnormal and normal LFTs were 1.2 (95% CI 1.21 to 1.28) and 0.76 (95% CI 0.68 to 0.84), respectively.

Conclusions A significant proportion (40%) of patients with suspected ADHF was missing LFTs in their ED workup. Among patients with LFTs, abnormal LFTs are associated with discharge diagnosis of ADHF after accounting for potential confounders, but their diagnostic value was relatively low. Future prospective studies are warranted to explore the role of LFTs in the workup of ADHF.

  • heart failure
  • quality in health care
  • adult cardiology

Data availability statement

No data are available.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2021-055216

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    Data availability statement

    No data are available.

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    Footnotes

    • Twitter @ecvasti

    • Contributors Each author contributed equally to the planning, conduct and reporting of the work described in the manuscript. Concept, design, analysis of the data, interpretation of the data and writing of the manuscript draft were performed by EV. Design, analysis, interpretation of the data and writing/extensive editing of the manuscript were performed by MP. Interpretation of the data and writing/extensive editing of the manuscript were performed by JAT. Provision of the data, writing/extensive editing of the manuscript were performed by AH. EV serves as guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.