Takao Kato1, Hidenori Yaku1, Takeshi Morimoto2, Yasutaka Inuzuka3, Yodo Tamaki4, Neiko Ozasa1, Erika Yamamoto1, Yusuke Yoshikawa1, Takeshi Kitai5, Ryoji Taniguchi6, Moritake Iguchi7, Masashi Kato8, Mamoru Takahashi9, Toshikazu Jinnai10, Tomoyuki Ikeda11, Kazuya Nagao12, Takafumi Kawai13, Akihiro Komasa14, Ryusuke Nishikawa15, Yuichi Kawase16, Takashi Morinaga17, Mitsunori Kawato18, Yuta Seko19, Masayuki Shiba1, Mamoru Toyofuku20, Yutaka Furukawa5, Kenji Ando17, Kazushige Kadota16, Yukihito Sato6, Koichiro Kuwahara21, Takeshi Kimura1. 1. Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan. 2. Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan. 3. Department of Cardiovascular Medicine, Shiga General Hospital, Shiga, Japan. 4. Division of Cardiology, Tenri Hospital, Nara, Japan. 5. Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan. 6. Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan. 7. Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan. 8. Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan. 9. Department of Cardiology, Shimabara Hospital, Kyoto, Japan. 10. Department of Cardiology, Japanese Red Cross Otsu Hospital, Shiga, Japan. 11. Department of Cardiology, Hikone Municipal Hospital, Shiga, Japan. 12. Department of Cardiology, Osaka Red Cross Hospital, Osaka, Japan. 13. Department of Cardiology, Kishiwada City Hospital, Osaka, Japan. 14. Department of Cardiology, Kansai Electric Power Hospital, Osaka, Japan. 15. Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan. 16. Department of Cardiology, Kurashiki Central Hospital, Okayama, Japan. 17. Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan. 18. Department of Cardiology, Kobe City Nishi-Kobe Medical Center, Hyogo, Japan. 19. Kitano Hospital, Osaka, Japan. 20. Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan. 21. Department of Cardiovascular Medicine, Shinshu University Graduate School of Medicine, Matsumoto, Japan.
Abstract
BACKGROUND: Despite the prognostic importance of hypoalbuminemia, the prognostic implication of a change in albumin levels has not been fully investigated during hospitalization in patients with acute decompensated heart failure (ADHF). METHODS: Using the data from the Kyoto Congestive Heart Failure registry on 3160 patients who were discharged alive for acute heart failure hospitalization and in whom the change in albumin levels was calculated at discharge, we evaluated the association with an increase in serum albumin levels from admission to discharge and clinical outcomes by a multivariable Cox hazard model. The primary outcome measure was a composite of all-cause death or hospitalization for heart failure. FINDINGS: Patients with increased albumin levels (N = 1083, 34.3%) were younger and less often had smaller body mass index and renal dysfunction than those with no increase in albumin levels (N = 2077, 65.7%). Median follow-up was 475 days with a 96% 1-year follow-up rate. Relative to the group with no increase in albumin levels, the lower risk of the increased albumin group remained significant for the primary outcome measure (hazard ratio: 0.78, 95% confidence interval: 0.69-0.90: P = 0.0004) after adjusting for confounders including baseline albumin levels. When stratified by the quartiles of baseline albumin levels, the favorable effect of increased albumin was more pronounced in the lower quartiles of albumin levels, but without a significant interaction effect (interaction P = 0.49). CONCLUSIONS: Independent of baseline albumin levels, an increase in albumin during index hospitalization was associated with a lower 1-year risk for a composite of all-cause death and hospitalization in patients with acute heart failure.
BACKGROUND: Despite the prognostic importance of hypoalbuminemia, the prognostic implication of a change in albumin levels has not been fully investigated during hospitalization in patients with acute decompensated heart failure (ADHF). METHODS: Using the data from the Kyoto Congestive Heart Failure registry on 3160 patients who were discharged alive for acute heart failure hospitalization and in whom the change in albumin levels was calculated at discharge, we evaluated the association with an increase in serum albumin levels from admission to discharge and clinical outcomes by a multivariable Cox hazard model. The primary outcome measure was a composite of all-cause death or hospitalization for heart failure. FINDINGS:Patients with increased albumin levels (N = 1083, 34.3%) were younger and less often had smaller body mass index and renal dysfunction than those with no increase in albumin levels (N = 2077, 65.7%). Median follow-up was 475 days with a 96% 1-year follow-up rate. Relative to the group with no increase in albumin levels, the lower risk of the increased albumin group remained significant for the primary outcome measure (hazard ratio: 0.78, 95% confidence interval: 0.69-0.90: P = 0.0004) after adjusting for confounders including baseline albumin levels. When stratified by the quartiles of baseline albumin levels, the favorable effect of increased albumin was more pronounced in the lower quartiles of albumin levels, but without a significant interaction effect (interaction P = 0.49). CONCLUSIONS: Independent of baseline albumin levels, an increase in albumin during index hospitalization was associated with a lower 1-year risk for a composite of all-cause death and hospitalization in patients with acute heart failure.
Authors: Giovanni Corsetti; Evasio Pasini; Claudia Romano; Carol Chen-Scarabelli; Tiziano M Scarabelli; Vincenzo Flati; Louis Saravolatz; Francesco S Dioguardi Journal: Int J Mol Sci Date: 2021-03-24 Impact factor: 5.923