Score based on heart, liver markers may predict future disease risk in PAH
Study: Novel TBI index combines two routine tests, achieves higher accuracy
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A novel score calculated based on markers of liver and heart health may help to predict the risk of future clinical worsening in people with pulmonary arterial hypertension (PAH), according to a new study.
“This study utilized routine [tests] to estimate [blood flow] parameters and established a novel hepatic-cardiac index for prognostic assessment” in PAH, researchers wrote.
The study, “Development and validation of novel prognostic hepatic-cardiac index and hemodynamic prediction models in pre-capillary pulmonary hypertension patients,” was published in Scientific Reports.
PAH can put strain on both the heart and the liver
PAH is marked by abnormally high pressure in the vessels that carry blood from the heart through the lungs. Currently, there’s a lack of reliable, noninvasive tests that can predict the risk of future disease activity in people with PAH. In addition, analyses including laboratory tests and echocardiography (sound waves used to create images of the heart and visualize how blood flows) have rarely explored how different indicators correlate.
Seeking to find a test to fill these gaps, scientists in China combed through clinical data from 179 people with PAH who received care at one of three centers in China. The researchers looked at several lab parameters, using statistical models to search for tests that could accurately predict the risk of clinical worsening events up to four years later.
The researchers zeroed in on two markers: one, called B-type natriuretic peptide or BNP, is a well-established marker of heart health. The other, called bilirubin, is a yellowish waste product that’s normally broken down by the liver. Elevated bilirubin is usually indicative of liver damage, as liver diseases characteristically cause the skin and eyes to turn yellow (known as jaundice).
Using these two markers, the researchers devised a novel risk score called the hepatic-cardiac index or TBI. This score is calculated by multiplying BNP levels by total bilirubin levels, then taking the logarithm. The researchers found that this TBI score could predict the risk of future clinical worsening with greater accuracy than BNP alone.
The scientists noted that the heart and the liver are frequently assessed separately in people with pulmonary hypertension. However, when delving into the biology of the disease, their findings make sense because PAH can put strain on both the heart and the liver. The heart is responsible for pumping blood through the lungs, so PAH can cause stress to the heart. Meanwhile, the liver is full of blood vessels and the right-sided heart strain in PAH leads to blood backing up into the liver veins
The scientists stressed that their new index was based on findings from a small number of patients at a few centers, so further work to validate and expand on their findings is required.
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