Liver Biomarkers As Predictors of Prognosis in Heart Failure With Preserved Ejection Fraction: A Systematic Review and Meta-Analysis Publisher Pubmed



Dastjerdi P¹ ; Mahalleh M¹ ; Shayesteh H¹ ; Najafi MS¹ ; Narimanijavid R² ; Dashtkoohi M³ ; Mofidi SA⁴ ; Hosseini K^{1, 5} ; Tajdini M¹ Show Affiliations
Source: BMC Cardiovascular Disorders Published:2025

Abstract

Background: Heart failure with preserved ejection fraction (HFpEF) accounts for 50% of heart failure cases, with increasing prevalence due to aging and risk factors such as hypertension and obesity. Liver dysfunction is common in HFpEF and may impact prognosis. This systematic review and meta-analysis aimed to evaluate the prognostic value of liver function markers (albumin, bilirubin, AST, ALT, ALP) in HFpEF patients. Methods: A systematic search of PubMed, Embase, Web of Science, and Scopus was conducted for studies assessing the association of liver markers with adverse outcomes in HFpEF. The primary outcome was a composite of heart failure-related hospitalization or death. Hazard ratios (HR) were pooled using a random-effects model, and heterogeneity was assessed using the I² statistic. Results: Twenty studies involving 30,623 patients were included. Serum albumin, the main marker of our study, was significantly associated with a reduced risk of adverse outcomes in a meta-analysis of 16 studies (HR 0.71, 95% CI: 0.61–0.83; I² = 87%). After excluding outliers, heterogeneity decreased (I² = 23%), and the association remained significant (HR 0.75, 95% CI: 0.69–0.82). Although no significant associations were found for AST, ALT, ALP, or bilirubin with adverse outcomes, the limited number of studies for these markers may have contributed to the lack of statistical significance. Conclusion: Higher serum albumin levels predict better outcomes in HFpEF, while other liver function markers showed limited prognostic utility. Serum albumin may serve as a valuable marker for risk stratification in HFpEF. © The Author(s) 2025.