High Burden of Biochemical Liver Function Test Abnormalities and Clinical Implications in Chronic Heart Failure Patients: A Cross Sectional Study at a Tertiary Hospital in Rwanda

Abstract

Background: Chronic heart failure (CHF), a significant global health burden, precipitates multi-organ dysfunction, including liver impairment. However, data on biochemical liver function test (LFT) profiles in Africa settings remain limited. This study aimed to determine the prevalence and severity of biochemical LFT abnormalities among Rwandan CHF patients and examine their association with the cardiac function category (New York Heart Association [NYHA] class).
Methods: A hospital-based cross-sectional study was conducted among 65 adults with confirmed CHF at the University Teaching Hospital of Butare (CHUB) from March to May 2025. Consecutive adult patients (≥18 years) with CHF were recruited from both outpatient and inpatient wards. Participants provided written informed consent before commencing study procedures. Sociodemographic and clinical data were collected using a structured questionnaire. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gammaglutamyl transferase (GGT), total bilirubin (TBil) and albumin were analysed using the Architect ci4100 chemistry autoanalyser. Biochemical LFT abnormalities were defined according to manufacturer‑specified reference intervals. Associations between LFTs and NYHA class were analysed using the chi-square test.
Results: Liver function test abnormalities were observed in most study participants. The most frequent derangements were elevated ALP (n=54, 83.08%), TBil (n=51, 78.46%), hypoalbuminaemia (n=48, 73.85%), and elevated GGT (n=46, 70.77%). Aminotransferase elevations were less common with ALT abnormal (n=32, 49.23%) and AST (n=24, 36.92%). Significant associations were identified between NYHA class and hypoalbuminaemia (P=.012) as well as elevated GGT (P=.034), with abnormalities becoming more frequent in patients with more severe functional classes.
Conclusion: Biochemical liver dysfunction, predominantly cholestatic abnormalities and hypoalbuminaemia, is common among Rwandan CHF patients and increases with advancing symptom severity. Routine monitoring of liver function tests can aid early detection of decompensation, guide timely nutritional and decongestive interventions, and support individualized management strategies to improve outcomes.