Article Text

PDF
Original article
Low prealbumin is strongly associated with adverse outcome in heart failure
  1. Patrícia Lourenço1,
  2. Sérgio Silva1,
  3. Fernando Friões1,
  4. Margarida Alvelos1,
  5. Marta Amorim1,
  6. Marta Couto1,
  7. Paulo Torres-Ramalho1,
  8. João Tiago Guimarães2,3,
  9. José Paulo Araújo1,
  10. Paulo Bettencourt1
  1. 1Serviço de Medicina Interna, Centro Hospitalar São João, Faculdade de Medicina da Universidade do Porto, Unidade I&D Cardiovascular do Porto, Porto, Portugal
  2. 2Serviço de Patologia Clínica, Centro Hospitalar São João, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
  3. 3Departamento de Bioquímica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
  1. Correspondence to Dr Patrícia Lourenço, Serviço de Medicina Interna, Centro Hospitalar São João, Faculdade de Medicina da Universidade do Porto, Unidade I&D Cardiovascular do Porto, Hospital S. João, Alameda Professor Hernâni Monteiro, Porto 4202-451, Portugal; pamlourenco{at}yahoo.com

Abstract

Objective Prealbumin is one of the best indicators of nutritional status. We previously showed that prealbumin predicted in-hospital mortality in heart failure (HF) patients. We evaluated if a low discharge prealbumin after admission with acute HF would predict morbidity and mortality.

Methods We conducted a prospective observational study. Patients admitted with a primary diagnosis of HF were studied. Follow-up was up to 6 months. Endpoints analysed were: all-cause and HF-death; all-cause and worsening HF hospitalisation. Patients with discharge prealbumin ≤15.0 mg/dL and those with prealbumin >15 mg/dL were compared. A Cox-regression analysis was used to evaluate the prognostic impact of low prealbumin.

Results We studied 514 patients. Mean age was 78 years and 45.7% were male. During follow-up, 101 patients died (78 for HF) and 209 patients were hospital readmitted (140 for worsening HF). Median prealbumin was 20.1 (15.3–25.3) mg/dL. Patients with lower prealbumin were more often women, older aged and with non-ischaemic HF; they had lower albumin, haemoglobin and total cholesterol; and higher glomerular filtration rate, C-reactive protein, B-type natriuretic peptide and length of hospital stay. Lower prealbumin associated with less β-blocker and statin use. Patients with discharge prealbumin ≤15 mg/dL had a multivariate adjusted HR of 6-month all-cause and HF death of 1.67 (1.00 to 2.80) and 2.12 (1.19 to 3.79) respectively and of all-cause and HF readmission of 1.47 (1.01 to 2.14) and 1.58 (1.01 to 2.47).

Conclusions Patients with discharge prealbumin ≤15 mg/dL have an higher risk of 6 months morbidity and mortality. The unbalance between protein–energy demands and its availability predicts ominous HF outcome.

  • Heart Failure

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.