Gotsman Israel, Shauer Ayelet, Zwas Donna R, Tahiroglu Ilgar, Lotan Chaim, Keren Andre
Heart Institute, Hadassah University Hospital, Jerusalem, Israel.
Heart Failure Center, Clalit Health Services, Jerusalem, Israel.
Clin Cardiol. 2019 Mar;42(3):365-372. doi: 10.1002/clc.23153. Epub 2019 Feb 7.
Low serum albumin is common in patients with chronic heart failure (HF).
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.
All patients with HF at a health maintenance organization were followed for cardiac-related hospitalizations and death.
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.
Low albumin provides important information regarding several detrimental processes in HF and is a significant predictor of a worse outcome in these patients.
血清白蛋白水平低在慢性心力衰竭（HF）患者中很常见。
白蛋白可能对HF患者的临床结局有影响。我们评估了白蛋白水平对HF真实世界队列患者临床结局的影响。
对一家健康维护组织中的所有HF患者进行心脏相关住院和死亡情况随访。
共有5779例HF患者纳入研究；平均随访576天；血清白蛋白中位数为4.0g/dL（四分位间距3.7 - 4.2），12%的患者有低白蛋白血症（白蛋白<3.5g/dL）。低白蛋白与年龄增加、尿素和C反应蛋白水平升高、血钠、血红蛋白、铁水平降低、血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂治疗减少、右心室功能降低及肺动脉高压相关。对显著预测因素进行校正后的Cox回归分析表明，白蛋白四分位数降低与死亡率显著相关：最低四分位数与最高四分位数相比：风险比（HR）5.74，95%置信区间（CI）4.08至8.07，P<0.001。对白蛋白作为连续参数进行校正后使用受限立方样条的Cox回归分析表明，白蛋白水平降低与死亡率增加直接相关（校正模型P<0.001）。白蛋白四分位数降低也是心脏相关住院增加的显著预测因素。随访时白蛋白降低是Cox回归分析中死亡率增加的独立预测因素：HR 2.58，95%CI 2.12至3.14，P<0.001。
低白蛋白提供了关于HF中几个有害过程的重要信息，并且是这些患者预后较差的显著预测因素。
