Internal Medicine Department.
Cardiology Division, East Tennessee State University, Johnson City, Tennessee.
Medicine (Baltimore). 2021 Mar 12;100(10):e24785. doi: 10.1097/MD.0000000000024785.
Hypoalbuminemia (HA) is common in HF, however, its pathophysiology and clinical implications are poorly understood. While multiple studies have been published in the past decade investigating the role of serum albumin in HF, there is still no consensus on the prognostic value of this widely available measure. The objective of this study is to assess the prognostic role of albumin in heart failure (HF) patient.
Unrestricted searches of MEDLINE, EMBASE, Cochrane databases were performed. The results were screened for relevance and eligibility criteria. Relevant data were extracted and analyzed using Comprehensive Meta-Analysis software. The Begg and Mazumdar rank correlation test was utilized to evaluate for publication bias.
A total of 48 studies examining 44,048 patients with HF were analyzed. HA was found in 32% (95% confidence interval [CI] 28.4%-37.4%) HF patients with marked heterogeneity (I2 = 98%). In 10 studies evaluating acute HF, in-hospital mortality was almost 4 times more likely in HA with an odds ratios (OR) of 3.77 (95% CI 1.96-7.23). HA was also associated with a significant increase in long-term mortality (OR: 1.5; 95% CI: 1.36-1.64) especially at 1-year post-discharge (OR: 2.44; 95% CI: 2.05-2.91; I2 = 11%). Pooled area under the curve (AUC 0.73; 95% CI 0.67-0.78) was comparable to serum brain natriuretic peptide (BNP) in predicting mortality in HF patients.
Our results suggest that HA is associated with significantly higher in-hospital mortality as well as long-term mortality with a predictive accuracy comparable to that reported for serum BNP. These findings suggest that serum albumin may be useful in determining high-risk patients.
低白蛋白血症（HA）在心力衰竭（HF）中很常见，但其病理生理学和临床意义尚未被充分理解。尽管过去十年中有多项研究探讨了血清白蛋白在 HF 中的作用，但对于这种广泛可用的测量方法的预后价值仍没有共识。本研究旨在评估白蛋白在心力衰竭（HF）患者中的预后作用。
对 MEDLINE、EMBASE 和 Cochrane 数据库进行了无限制搜索。筛选结果以确定相关性和合格标准。使用 Comprehensive Meta-Analysis 软件提取和分析相关数据。使用 Begg 和 Mazumdar 等级相关检验评估发表偏倚。
共分析了 48 项研究，涉及 44048 例 HF 患者。HF 患者中有 32%（95%置信区间 [CI] 28.4%-37.4%）存在 HA，且存在明显的异质性（I2=98%）。在 10 项评估急性 HF 的研究中，HA 患者的住院死亡率几乎高出 4 倍，优势比（OR）为 3.77（95%CI 1.96-7.23）。HA 也与长期死亡率显著增加相关（OR：1.5；95%CI：1.36-1.64），尤其是在出院后 1 年（OR：2.44；95%CI：2.05-2.91；I2=11%）。曲线下面积（AUC 0.73；95%CI 0.67-0.78）的合并与血清脑钠肽（BNP）预测 HF 患者死亡率相当。
我们的研究结果表明，HA 与住院死亡率以及长期死亡率显著升高相关，其预测准确性与报道的血清 BNP 相当。这些发现表明血清白蛋白可能有助于确定高危患者。
