Serum albumin and mortality in acutely decompensated heart failure.
ABSTRACT Although hypoalbuminemia has been associated with decreased survival in chronic systolic heart failure (HF), its role for prognosticating outcomes in those with acutely decompensated heart failure (ADHF) has not been established.
438 consecutive patients with ADHF (mean age 75±13 years, mean left ventricular ejection fraction 41%±20%) admitted to a large community hospital were studied. The mean serum albumin level for the group was 3.4 g/dL; quintile analysis demonstrated an inflection of risk for death below this value. Patients with hypoalbuminemia (defined as a serum albumin<3.4 g/dL; N=236, 54% overall) were more likely to have prior HF, more severe HF symptoms, more likely to be edematous, and had more prevalent prognostically meaningful laboratory abnormalities, such as a higher frequency of renal dysfunction and elevated B-type natriuretic peptide. Independent associations between anemia, hyponatremia, lack of therapy with vasodilators at presentation, prior history of obstructive airways disease, severe tricuspid regurgitation, low serum cholesterol, and the presence of a pleural effusion on chest radiography were found with reduced serum albumin; interestingly, body mass index was not predictive of albumin levels. In Cox proportional hazards analysis, hypoalbuminemia predicted 1-year mortality (hazard ratio [HR]adjusted=2.05, 95% CI 1.10-3.81, P=.001). Reduced serum albumin concentrations were prognostic across a wide range of body mass index but had highest HR in obese patients (HRadjusted=4.39 [95% CI=1.66 to 11.60], P=.003). As well, hypoalbuminemia was mainly predictive of outcomes among those with systolic HF (HRadjusted=5.00, 95% CI=2.17-11.5, P<.001).
Hypoalbuminemia is common among patients with ADHF and is independently associated with increased one year mortality in patients admitted with ADHF.
- SourceAvailable from: Tomoko S Kato[show abstract] [hide abstract]
ABSTRACT: BACKGROUND: -Serum albumin concentration has been recognized as a marker of nutrition, severity of inflammation and hepatic function in patients with various chronic diseases. The purpose of this study was to investigate the impact of pre-transplant serum albumin concentration on post-transplant outcome in heart transplant (HTx) recipients. METHODS AND RESULTS: -Pre-operative laboratory variables including albumin concentration as well as donor-related information were obtained from 822 consecutive patients undergoing HTx at Columbia University Medical Center between 1999 and 2010. The association between pre-transplant albumin concentration and post-transplant one-year survival was analyzed. Available data from the United Network of Organ Sharing (UNOS) (n=13,671) was also analyzed to evaluate the impact of pre-operative albumin levels on post-transplant outcome. In our cohort, multivariable analysis revealed that preoperative albumin (mg/dL) [hazard ratio (HR) 0.46, p<0.0001] and pre-operative total bilirubin (mg/dL) (HR 1.26, p=0.0002) were associated with post-transplant one-year mortality. This implied that for every 1 mg/dL increase in albumin concentration, the post-transplant one-year mortality rate decreased by 54%. The Kaplan-Meier analysis based on our patients cohort and the UNOS dataset showed lower survival rate at one-year pos-transplant in patients with albumin levels≤3.5mg/dL compared to those with >3.5mg/dL (Our patients, 91.3 vs. 72.4%, p<0.0001; UNOS, 88.4 vs. 84.8%, p<0.0001). CONCLUSIONS: -Pre-transplant serum albumin concentration is a strong prognostic marker for post-transplant survival in HTx recipients.Circulation Heart Failure 05/2013; · 6.68 Impact Factor
- [show abstract] [hide abstract]
ABSTRACT: Obesity is an independent risk factor for the development of heart failure. Several recent studies have found better outcomes of heart failure for obese patients, an observation termed as the "obesity paradox." On the other hand, the negative effect of malnutrition on the evolution of heart failure has also been clearly established. Data from the Minimum Basic Data Set were analyzed for all patients discharged from all the departments of internal medicine in hospitals of the Spanish National Health System between the years 2006 and 2008. The information was limited to those patients with a primary or secondary diagnosis of heart failure. Patients with a diagnosis of obesity or malnutrition were identified. The mortality and readmission indexes of obese and malnourished patients were compared against the subpopulation without these diagnoses. A total of 370,983 heart failure admittances were analyzed, with 41,127 (11.1%) diagnosed with obesity and 4105 (1.1%) with malnutrition. In-hospital global mortality reached 12.9% and the risk of readmission was 16.4%. Obese patients had a lower in-hospital mortality risk (odds ratio [OR]: 0.65, 95% confidence interval [95%CI]: 0.62-0.68) and early readmission risk (OR: 0.81, 95%CI: 0.78-0.83) than nonobese patients. Malnourished patients had a much higher risk of dying while in hospital (OR: 1.83 95%CI: 1.69-1.97) or of being readmitted within 30 days after discharge (OR: 1.39, 95%CI: 1.29-1.51), even after adjusting for possible confounding factors. Obesity in patients admitted for HF substantially reduces in-hospital mortality risk and the possibility of early readmission, whereas malnutrition is associated with important increases in in-hospital mortality and risk of readmission in the 30 days following discharge.Revista Espanola de Cardiologia 11/2011; 65(5):421-6. · 3.20 Impact Factor
- [show abstract] [hide abstract]
ABSTRACT: Hypoalbuminemia has been recognized as a prognostic indicator in patients with heart failure. We aimed to investigate the association of hypoalbuminemia with postoperative mortality in patients undergoing left ventricular assist device (LVAD) implantation. We studied 272 consecutive patients undergoing LVAD implantation from 2000 to 2010 at our institution. Preoperative clinical characteristics and laboratory variables associated with mortality were analyzed. Postoperative survival of patients with preoperative hypoalbuminemia (<3.5 g/dl, n = 125) and those with normal albumin concentration (≥3.5 g/dl, n = 147) was compared. Survival after LVAD surgery was better in patients with normal albumin levels compared with those with hypoalbuminemia before surgery (3 and 12 months: 93.2% vs 82.4% and 88.4% vs 75.2%, respectively, p <0.001). Multivariate analysis revealed that preoperative albumin was independently associated with mortality after LVAD implantation (hazard ratio 0.521, 95% confidence interval 0.290 to 0.934; p = 0.029.) Furthermore, the impact of normalization of albumin levels during LVAD support on postoperative survival was analyzed in both groups. Subgroup analysis of patients with preoperative hypoalbuminemia and postoperative normalization of albumin levels (n = 81) showed improved survival compared with those who remained hypoalbuminemia (n = 44) or those who had decreasing albumin levels during LVAD support (n = 40; 3-month survival: 92.6% vs 63.6% and 65.0%; p <0.01). In conclusion, preoperative hypoalbuminemia is associated with poor prognosis after LVAD surgery. Postoperative normalization of albumin level is associated with improved survival. Attention to albumin levels by correcting nutrition, inflammation, and hepatic function could be an effective way to improve prognosis in patients evaluated for LVAD implantation.The American journal of cardiology 07/2013; · 3.58 Impact Factor