Relationship between Hypoalbuminemia on Admission and Long-term Mortality in Patients with Acute Decompensated Heart Failure

• Published in: Internal Medicine Vol. 58; no. 12; pp. 1695 - 1702
• Main Authors: Yatsu, Shoichiro, Kasai, Takatoshi, Matsumoto, Hiroki, Shitara, Jun, Shimizu, Megumi, Murata, Azusa, Kato, Takao, Suda, Shoko, Hiki, Masaru, Takagi, Atsutoshi, Daida, Hiroyuki
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 15.06.2019; Japan Science and Technology Agency
• Subjects: acute decompensated heart failure; Congestive heart failure; Heart failure; hypoalbuminemia; Internal medicine; long-term mortality; Mortality; Original; propensity score matching; Regression analysis; serum albumin; long-term mortality; acute decompensated heart failure; propensity score matching; serum albumin; hypoalbuminemia
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.1716-18

Objective Although several studies have reported the relationship between hypoalbuminemia and the clinical outcome, it remains disputable in patients with acute decompensated heart failure (ADHF). We therefore investigated the relationship between hypoalbuminemia on admission and long-term mortality in hospitalized patients following ADHF. Methods We examined a cohort of 751 consecutive patients who were admitted to the cardiac intensive-care unit between 2007 and 2011 with a diagnosis of ADHF. These patients were divided into 2 groups according to the presence or absence of hypoalbuminemia on admission, which was defined as a serum albumin ≤3.4 g/dL. A propensity score (PS) was calculated to evaluate the effects of variables related to the presence or absence of hypoalbuminemia. The association between hypoalbuminemia and mortality was assessed using two Cox regression models-namely, conventional adjustment and matching patients with and without hypoalbuminemia using the PS. Results Among the pre-match patients (n=551), 311 (56%) were classified as exhibiting hypoalbuminemia on admission. There were 152 deaths (27.5%), and the median follow-up was 1.9 years. The presence of hypoalbuminemia on admission tended to be associated with increased mortality in the unadjusted model [hazard ratio (HR) 1.32, 95% confidence interval (95% CI) 0.95-1.84; p=0.098] but not in the conventional adjusted model (HR 0.98, 95% CI 0.64-1.52; p=0.938). Even in post-match patients, no association between hypoalbuminemia and mortality was observed (HR 1.09, 95% CI 0.68-1.76; p=0.722). Conclusion Hypoalbuminemia on admission was not associated with long-term mortality in patients with ADHF, even if PS matching was used.