Serum albumin and mortality in acutely decompensated heart failure
Division of Cardiology, Massachusetts General Hospital, Boston, MA 02114, USA. American heart journal
(Impact Factor: 4.46).
12/2010; 160(6):1149-55. DOI: 10.1016/j.ahj.2010.09.004
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.
Available from: Hye Sun Lee
- "Red cell distribution width (RDW), a measure of size variability among red blood cells, has been found to be a prognostic marker in patients with HF and acute dyspnea.4,5,6,7,8 Although the mechanism for the association between increased RDW and poor prognosis in HF is not clearly elucidated, chronic inflammation, kidney dysfunction, hepatic congestion, and nutritional deficiencies in HF were suggested for the underlying mechanism for the increased RDW.9,10,11,12 Therefore, we hypothesized that a higher RDW, which represents an increased severity of and an adverse prognosis for HF, would be related to exercise intolerance or ventilatory inefficiency, the measurements reflecting the severity of HF, especially in patients with chronic HF (CHF). "
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ABSTRACT: Peak oxygen uptake (peak VO₂) and ventilatory inefficiency (VE/VCO₂ slope) have proven to be strong prognostic markers in patients with chronic heart failure (CHF). Recently increased red cell distribution width (RDW) has emerged as an additional predictor of poor outcome in CHF. We sought to evaluate the relationship between RDW and cardiopulmonary exercise test (CPET) parameters in CHF patients and healthy controls.
85 ambulatory CHF patients (68 men, 54±10 years) and 107 healthy controls, who underwent a symptom-limited CPET on a treadmill according to the modified Bruce ramp protocol, were enrolled. CHF patients and healthy controls were divided into RDW tertile groups and laboratory, echocardiographic, and CPET results were analyzed.
For patients with CHF, compared with patients in the lowest RDW tertile, those in the highest tertile had lower peak VO₂ (22 mL/kg/min vs. 28 mL/kg/min, p<0.001) and higher VE/VCO₂ slope (31 vs. 25, p=0.004). Multivariate regression analysis revealed RDW to be an independent predictor for peak VO₂ (β=-0.247, p=0.035) and VE/VCO₂ slope (β=0.366, p=0.004). The optimal cutoff value of RDW for predicting peak VO₂ ≤20 mL/kg/min and VE/VCO₂ slope≥34 was 13.6% (sensitivity 53%, specificity 89%) and 13.4% (sensitivity 75%, specificity 82%), respectively. In contrast, for healthy controls, RDW was not related to both peak VO₂ and VE/VCO₂ slope.
Higher RDW is independently related to peak VO₂ and VE/VCO₂ slope only in patients with CHF. RDW assessment, an inexpensive and simple method, might help predict functional capacity and ventilatory efficiency in these patients.
Available from: Taro Narumi
- "Several studies have shown an association between a single nutritional indicator and poor outcomes in patients with CHF     . However, assessment of only one indicator of malnutrition may not provide adequate prognostic information . "
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ABSTRACT: Although malnutrition indicates an unfavorable prognosis in some clinical settings, the association between nutritional indexes and outcomes for patients with chronic heart failure (CHF) is unclear.
All the previously established objective nutritional indexes were evaluated. The controlling nutritional status score (CONUT), prognostic nutritional index (PNI), and geriatric nutritional risk index (GNRI) were determined for 388 consecutive patients with CHF (mean age 69.6±12.3 years). The prevalence of malnutrition in this cohort was 60-69%. Patients were followed prospectively, with the endpoints being death due to a cardiovascular event or re-hospitalization. There were 130 events, including 33 deaths and 97 re-hospitalizations, during a mean follow-up period of 28.4 months. Patients experiencing cardiovascular events showed impaired nutritional status, higher CONUT scores, lower PNI scores, and lower GNRI scores, compared with those who did not experience cardiovascular events. CONUT score [hazard ratio 40.9, 95% confidence interval (CI) 10.8-154.8], PNI score (hazard ratio 6.4, 95% CI 5.4-25.1), and GNRI score (hazard ratio 11.6, 95% CI 3.7-10.0) were independently associated with cardiovascular events. Kaplan-Meier analysis showed that there was a significantly higher incidence of cardiovascular events in patients who were malnourished than in those who were not.
Malnutrition was common in patients with CHF. Evaluation of nutritional status may provide additional prognostic information in patients with CHF.
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ABSTRACT: Maintaining proper fuel cell membrane humidification is a key challenge in achieving optimal fuel cell performance. For automotive applications, the load and environment conditions are constantly changing. Therefore, the membrane humidity needs to be properly controlled during transients. A humidifier system using water vapor exchange membrane is modeled and analyzed in this paper. The 4-state humidifier model is integrated with a fuel cell stack. Feedback and feed-forward control algorithms are developed so that the fuel cell maintains its highest membrane water content under a wide range of operation conditions without flooding.
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