González-Pacheco Héctor, Amezcua-Guerra Luis M, Sandoval Julio, Martínez-Sánchez Carlos, Ortiz-León Xochitl A, Peña-Cabral Marco A, Bojalil Rafael
Coronary Care Unit, National Institute of Cardiology in Mexico City, Mexico.
Department of Immunology, National Institute of Cardiology in Mexico City, Mexico; Department of Health Care, Metropolitan Autonomous University, National Institute of Cardiology in Mexico City, Mexico.
Am J Cardiol. 2017 Apr 1;119(7):951-958. doi: 10.1016/j.amjcard.2016.11.054. Epub 2017 Jan 5.
Hypoalbuminemia is a long-term risk factor for incident of both myocardial infarction and heart failure. We assessed whether serum albumin levels at admission are associated with new-onset heart failure and in-hospital mortality in patients with acute coronary syndrome (ACS). The study included 7,192 patients with ACS with no previous history of heart failure. Patients were divided into quartiles according to serum albumin levels (Q1: ≤3.50 g/dl; Q2: 3.51 to 3.80 g/dl; Q3: 3.81 to 4.08 g/dl; and Q4: >4.08 g/dl). Logistic regressions were used to explore the relations among serum albumin quartiles, new-onset heart failure, and in-hospital mortality. Serum albumin levels were negatively correlated with both high-sensitivity C-reactive protein and white blood cell count at admission. The unadjusted rate for both new-onset heart failure (37.7%, 20.2%, 14.7%, and 11.4% for Q1, Q2, Q3, and Q4, respectively; p <0.0001) and in-hospital mortality (9.8%, 3.4%, 2.0%, and 1.7% for Q1, Q2, Q3, and Q4, respectively; p <0.0001) were higher at lower serum albumin levels. Multivariate analysis demonstrated that serum albumin level ≤3.50 g/dl is an important and independent predictor of both the development of new-onset heart failure (odds ratio 2.31, 95% CI 1.87 to 2.84, p <0.0001) and in-hospital mortality (odds ratio 1.88, 95% CI 1.23 to 2.86, p = 0.003). In conclusion, albumin level ≤3.50 g/dl is an independent predictor of new-onset heart failure and in-hospital mortality in patients with ACS. The inflammatory state may be a mechanism underlying hypoalbuminemia in this clinical setting.
低白蛋白血症是心肌梗死和心力衰竭发病的长期危险因素。我们评估了急性冠状动脉综合征（ACS）患者入院时的血清白蛋白水平是否与新发心力衰竭及院内死亡率相关。该研究纳入了7192例既往无心力衰竭病史的ACS患者。根据血清白蛋白水平将患者分为四分位数（Q1：≤3.50 g/dl；Q2：3.51至3.80 g/dl；Q3：3.81至4.08 g/dl；Q4：>4.08 g/dl）。采用逻辑回归分析探讨血清白蛋白四分位数、新发心力衰竭和院内死亡率之间的关系。入院时血清白蛋白水平与高敏C反应蛋白和白细胞计数均呈负相关。新发心力衰竭的未调整发生率（Q1、Q2、Q3和Q4分别为37.7%、20.2%、14.7%和11.4%；p<0.0001）和院内死亡率（Q1、Q2、Q3和Q4分别为9.8%、3.4%、2.0%和1.7%；p<0.0001）在较低血清白蛋白水平时更高。多因素分析表明，血清白蛋白水平≤3.50 g/dl是新发心力衰竭发生（比值比2.31，95%可信区间1.87至2.84，p<0.0001）和院内死亡率（比值比1.88，95%可信区间1.23至2.86，p = 0.003）的重要且独立预测因素。总之，白蛋白水平≤3.50 g/dl是ACS患者新发心力衰竭和院内死亡率的独立预测因素。在这种临床情况下，炎症状态可能是低白蛋白血症的潜在机制。
