Serum albumin and short-term risk for mortality and cardiovascular disease among HIV-infected veterans

• Published in: AIDS (London) Vol. 27; no. 8; pp. 1339 - 1343
• Main Authors: JOSHUA LANG, SCHERZER, Rebecca, WEEKLEY, Cristin C, TIEN, Phyllis C, GRUNFELD, Carl, SHLIPAK, Michael G
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 15.05.2013
• Subjects: AIDS/HIV; Biological and medical sciences; Cardiovascular Diseases - blood; Cardiovascular Diseases - mortality; Cohort Studies; Female; HIV Infections - blood; HIV Infections - mortality; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infectious diseases; Male; Medical sciences; Models, Theoretical; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Renal failure; Retrospective Studies; Risk Factors; Serum Albumin - analysis; Time Factors; United States; Veterans - statistics & numerical data; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; United States; Kidney disease; Short term; Immunopathology; Urinary system disease; Filtration; Prognosis; Chronic renal failure; glomerular filtration rate; Mortality; Albumin; Cardiovascular disease; AIDS; Serum albumin; end-stage renal disease; Immune deficiency; Kidney; Infection; Viral disease; Risk factor
• ISSN: 0269-9370; 1473-5571
• DOI: 10.1097/qad.0b013e32835f1dd6

We examined the short-term and long-term associations of serum albumin with mortality and cardiovascular disease among HIV-infected veterans. Retrospective cohort analysis using a national database of US veterans with HIV infection. This analysis evaluated all HIV-infected veterans in the Department of Veterans Affairs HIV Clinical Case Registry (CCR), a national database consisting of demographic, clinical, laboratory, pharmaceutical, and viral status data. There were 25 522 patients enrolled between 1986 and 2007. We evaluated the associations of baseline and time-updated serum albumin levels with all-cause mortality, atherosclerotic cardiovascular disease, and heart failure by multivariate proportional hazards models. Over 21 years, there were 10 869 deaths; the cumulative mortality was 73.2 per 1000 person-years. After multivariate adjustment for covariates measured at baseline, the lowest category of serum albumin (<2.5 g/dl) was associated with a higher mortality risk compared with the highest category (>4 g/dl; hazard ratio 3.00; 2.67-3.37). When analyzed as a time-dependent model, the association strengthened substantially (15.1; 14.0-16.4). Findings were similar for atherosclerotic cardiovascular disease and heart failure. We stratified the baseline mortality model by year of follow-up and found that albumin was more strongly associated with deaths that occurred within 1 year of baseline (9.29; 7.85-11.0) than in the second (1.66; 1.18-2.33) or third (1.22; 0.77-1.96) year after measurement. Among ambulatory HIV-infected patients, lower serum albumin levels are strongly predictive of mortality risk, particularly within 1 year.