Association Between Albumin Level and Mortality Among Cardiac Icu Patients

Abstract

Hypoalbuminemia is associated with worse outcomes in critically ill patients. We hypothesized that hypoalbuminemia would be associated with higher short-and long-term mortality in unselected Cardiac Intensive Care Unit (CICU) patients. METHODS: We retrospectively reviewed 12,418 unique CICU patients from 2007 to 2018. Hypoalbuminemia was defined as an admission albumin level < 3.5 g/dL. Predictors of hospital mortality were identified using multivariable logistic regression with stepwise variable selection. RESULTS: We included 2,680 patients (22%) with a measured admission albumin level. The median age was 68 (39% females). Admission diagnoses included acute coronary syndrome (ACS; 31%), heart failure (HF; 67%), cardiac arrest (15%), and cardiogenic shock (20%). The median albumin level was 3.4 (IQR 2.9, 3.8) g/dL, and 55% of patients had hypoalbuminemia. Patients with hypoalbuminemia were older, with more comorbidities, and higher illness severity. Hospital mortality occurred in 16%, and patients with hypoalbuminemia had higher hospital mortality (21% vs. 9%, adjusted OR 2.64, 95% CI 2.09-3.34, p < 0.001). Albumin level was inversely associated with hospital mortality (adjusted OR 0.60 per 1 g/dL higher albumin level, 95% CI 0.47-0.75, p < 0.001), with a stepwise increase in the hospital mortality at lower albumin levels that was present in patients with ACS or HF. Post-discharge mortality was higher in hospital survivors with hypoalbuminemia, and increased as a function of lower albumin levels. CONCLUSIONS: Hypoalbuminemia is common in CICU patients and associated with higher short-and long-term mortality. Progressively lower serum albumin was incrementally associated with higher hospital and post-discharge mortality. CLINICAL IMPLICATIONS: Hypoalbuminemia is a common occurrence in critically-ill patients. This study demonstrates that hypoalbuminemia can be used as a negative prognostic factor in critically-ill cardiac intensive care unit patients. Prior studies have demonstrated the relationship between hypoalbuminemia and mortality in intensive care units but this is the largest study to exemplify this relationship in cardiac intensive care unit patients.

Prognostic Value of Serum Albumin Level in Critically Ill Patients: Observational Data From Large Intensive Care Unit Databases

“…Low SAL has been considered as a prognostic indicator among patients with a wide range of conditions, including cardiovascular diseases, cirrhosis, sepsis, cancer, and chronic obstructive pulmonary disease ( 5 – 12 ). However, studies on the prognostic value of SAL in general ICUs have been relatively rare and limited in sample size ( 5 , 13 – 17 ).…”