Low serum albumin: A significant predictor of reduced survival in patients with chronic heart failure

Abstract

Background Low serum albumin is common in patients with chronic heart failure (HF). Hypothesis Albumin may have an impact on clinical outcome in HF. We evaluated the effect of albumin levels on clinical outcome in a real‐world cohort of patients with HF. Methods All patients with HF at a health maintenance organization were followed for cardiac‐related hospitalizations and death. Results A total of 5779 HF patients were included in the study; mean follow‐up was 576 days; median serum albumin was 4.0 g/dL (interquartile range 3.7‐4.2), and 12% of the patients had hypoalbuminemia (albumin<3.5 g/dL). Low albumin was associated with increasing age, higher urea and C‐reactive protein, lower sodium, hemoglobin, iron, less treatment with angiotensin‐converting enzyme inhibitor or angiotensin receptor blocker, reduced right ventricular function, and pulmonary hypertension. Cox regression analysis after adjustment for significant predictors demonstrated that decreasing quartiles of albumin was significantly associated with mortality: Lowest quartile compared to highest: hazard ratio (HR) 5.74, 95% confidence interval (CI) 4.08 to 8.07, P < 0.001. Cox regression analysis of albumin as a continuous parameter using restricted cubic splines after adjustment for significant parameters demonstrated that reduced albumin levels were directly associated with increased mortality ( P < 0.001 for the adjusted model). Decreasing quartiles of albumin were also a significant predictor of increased cardiac‐related hospitalizations. A decrease in albumin on follow‐up was an independent predictor of increased mortality by Cox regression analysis: HR 2.58, 95% CI 2.12 to 3.14, P < 0.001. Conclusions Low albumin provides important information regarding several detrimental processes in HF and is a significant predictor of a worse outcome in these patients.

Comparison of risk models for mortality and cardiovascular events between machine learning and conventional logistic regression analysis

“…In the present study, albumin was commonly determined as the top predictor in both of ML and LR models. Although several recent studies have identified hypoalbuminemia as an independent predictor of mortality in CVD[20] (i.e., HF,[21–23] myocardial infarction,[24–26] or hemodialysis[27–29]), albumin was not included in most of the risk scores for mortality in CVD. [30–35] The insufficient recognition of albumin as a risk factor for mortality may be due to the strong interaction with other risk factors (i.e., hemoglobin and body weight) or missing values in previous observational studies due to the low attention to its risk.…”

High Erythropoiesis Resistance Index Is a Significant Predictor of Cardiovascular and All-Cause Mortality in Chinese Maintenance Hemodialysis Patients

“…Albumin and creatinine were both indicators of nutrition status which was related to the development of malnutrition-inflammation-atherosclerosis (MIA) syndrome. Hypoalbuminemia was a relative predictor of ESA responsiveness and survival in hemodialysis patients [ 25 – 27 ], which was probably also associated with inflammatory reaction. Predialysis serum creatinine level, a potential surrogate of muscle mass, was negatively related to mortality in HD and peritoneal dialysis patients [ 28 , 29 ].…”

CUPRAC-Reactive Advanced Glycation End Products as Prognostic Markers of Human Acute Myocardial Infarction

“…Albumin is found in both intra-and extracellular proteins, and its serum concentration is typically within the range of 35–50 g/L in healthy individuals. Furthermore, changes in serum albumin levels are associated with various disorders; for example, albumin concentration increases can be associated with prediabetes development, incident hemodialysis, and administration of certain types of drugs, while a decrease may be observed in patients with acute heart failure, sepsis, and hypoalbuminemia [ 35 , 36 , 37 , 38 , 39 ]. There-fore, we first determined the sensitivity of the CUPRAC assay regarding the glycation re-action that occurred in tubes containing different concentrations of BSA (2–10 mg/mL) and the same amount of glucose (0.1 M) in a phosphate buffer environment (pH = 7.4).…”