Serum albumin and mortality in acutely decompensated heart failure

doi:10.1016/j.ahj.2010.09.004

American Heart Journal

Volume 160, Issue 6, December 2010, Pages 1149-1155

https://doi.org/10.1016/j.ahj.2010.09.004 Get rights and content

Background

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.

Methods and Results

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 (HR_adjusted = 4.39 [95% CI = 1.66 to 11.60], P = .003). As well, hypoalbuminemia was mainly predictive of outcomes among those with systolic HF (HR_adjusted = 5.00, 95% CI = 2.17-11.5, P < .001).

Conclusion

Hypoalbuminemia is common among patients with ADHF and is independently associated with increased one year mortality in patients admitted with ADHF.

Section snippets

Patient population

The study population consisted of 438 consecutive patients with a primary diagnosis of ADHF that had available serum albumin data admitted to a large community based hospital, Catholic Medical Center, Manchester, NH. Patients were admitted between January 2006 and December 2007. The diagnosis of ADHF was assigned by managing clinicians in accordance with current practice guidelines.⁹ Exclusion criteria included acute myocardial infarction, current history of cancer, lack of echocardiographic

Results

Serum albumin levels were normally distributed; the mean serum albumin for the entire group was 3.4 ± 0.5 g/dL. Of patients, 54% (n = 236) had hypoalbuminemia. Baseline clinical characteristics of patients between the albumin groups are listed in Table I. Compared to patients with normal albumin levels, hypoalbuminemic patients were more likely to have class III/IV symptoms, to have lower extremity edema, and to have higher concentrations for blood urea nitrogen, serum creatinine and B-type

Discussion

In this large cohort of subjects with ADHF admitted to a community hospital, we have characterized patients with low serum albumin, a variable previously associated with risk in chronic systolic HF. Furthermore, we identified the independent predictors of hypoalbuminemia. Moreover, we demonstrated that hypoalbuminemia was associated with significant one year cardiac-related mortality across all BMI categories, and was mainly predictive of hazard in those with systolic dysfunction.

The

Conclusion

In conclusion, patients with ADHF and hypoalbuminemia have a more than 2-fold increased risk of mortality compared to those without hypoalbuminemia even after adjusting for multiple relevant prognostic variables, and persisting across all BMIs examined. The prognostic importance of low albumin was particularly present in those patients with systolic HF, a group where an even more marked prognostic meaning of hypoalbuminemia was observed. Serum albumin thus could serve as a simple prognostic

Disclosures

Funding sources: There was no funding for this research.

Conflict of interest: None declared.

Acknowledgements

Dr. Januzzi is supported in part by the Balson scholar award. The authors acknowledge the invaluable assistance of Cynthia David, MLS MPS.

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Clinical InvestigationCongestive Heart FailureSerum albumin and mortality in acutely decompensated heart failure

Background

Methods and Results

Conclusion

Section snippets

Patient population

Results

Discussion

Conclusion

Disclosures

Acknowledgements

J Clin Epidemiol

Am J Cardiol

Metabolism

Am Heart J

Ann Cardiol Angeiol

Am J Cardiol

Int J Cardiol

Chest

Lancet

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Int J Cardiol

Clinical Investigation
Congestive Heart Failure
Serum albumin and mortality in acutely decompensated heart failure