Liu Gang, Hu Xun, Long Ming, Du Zhi-Min, Li Yi, Hu Cheng-Heng
Department of Cardiology, The First Affiliated Hospital, Sun Yat-Sen University, and Key Laboratory on Assisted Circulation, Ministry of Health.
Int Heart J. 2020 Jan 31;61(1):67-76. doi: 10.1536/ihj.19-395. Epub 2020 Jan 17.
Pre-procedural serum albumin's impact on prognosis after transcatheter aortic valve replacement (TAVR) has been studied. Literature on the prognostic role of serum albumin in the survival of patients undergoing TAVR shows conflicting results. This meta-analysis was conducted to evaluate the impact of pre-procedural serum albumin on outcomes after TAVR. A comprehensive literature search of EMBASE, MEDLINE, and the Cochrane Library was undertaken through July 2019. The primary end points were 30-day and one-year all-cause mortality after TAVR. Risk ratios (HRs) and 95% confidence intervals (CIs) were calculated using the random-effect model. Ten eligible studies with 8,236 patients were analyzed. Of the 8,236 patients undergoing TAVR, with a mean age of 83 years, 48.8% were men and were categorized into two groups according to low and normal serum albumin (cut-off value: 3.5 or 4 g/dL). Overall, low albumin was significantly associated with an approximately two-fold increase in 30-day all-cause mortality (HR, 2.09; 95% CI, 1.53-2.86) and a 61% increase risk for one-year mortality (HR, 1.61; 95% CI, 1.31-1.98) in patients after TAVR. Sensitivity analyses showed the results to be robust. The association of low albumin level with an increase in one-year mortality risk was not modified by study design, albumin cut-off value, Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM), and study quality. In conclusion, low albumin levels were associated with poor prognosis in patients after TAVR. Pre-procedural albumin can be used as a simple tool related to prognosis after TAVR.
术前血清白蛋白对经导管主动脉瓣置换术（TAVR）后预后的影响已得到研究。关于血清白蛋白在接受TAVR患者生存中的预后作用的文献显示出相互矛盾的结果。进行这项荟萃分析是为了评估术前血清白蛋白对TAVR后结局的影响。截至2019年7月，对EMBASE、MEDLINE和Cochrane图书馆进行了全面的文献检索。主要终点是TAVR后30天和1年的全因死亡率。使用随机效应模型计算风险比（HR）和95%置信区间（CI）。分析了10项符合条件的研究，共8236例患者。在8236例接受TAVR的患者中，平均年龄83岁，48.8%为男性，根据血清白蛋白水平低和正常（临界值：3.5或4 g/dL）分为两组。总体而言，低白蛋白与TAVR后患者30天全因死亡率增加约两倍（HR，2.09；95%CI，1.53 - 2.86）以及1年死亡率风险增加61%（HR，1.61；95%CI，1.31 - 1.98）显著相关。敏感性分析表明结果是可靠的。低白蛋白水平与1年死亡风险增加之间的关联不受研究设计、白蛋白临界值、胸外科医师协会预测死亡率（STS - PROM）和研究质量的影响。总之，低白蛋白水平与TAVR后患者的不良预后相关。术前白蛋白可作为与TAVR后预后相关的一个简单工具。
