School of Nursing, University of Rochester, Rochester, NY, USA.
Medical Center, University of Rochester, Rochester, NY, USA.
Biol Res Nurs. 2025 Jan;27(1):37-46. doi: 10.1177/10998004241262530. Epub 2024 Jun 13.
Albumin plays a vital role in improving osmotic pressure and hemodynamics. A lower serum albumin level may cause pulmonary congestion and edema and contribute to myocardial dysfunction, diuresis resistance, and fluid retention in acute heart failure. We hypothesized that AHF patients with normal serum albumin have shorter hospital stays. Using Electronic Medical Records, patients admitted from May 2020 through May 2021 aged >18, ICD-10, and positive Framingham Heart Failure Diagnostic Criteria were included. We excluded patients without albumin records and eGFRs less than 30 mL/min/1.73 m. Prolonged hospitalization was defined as >8 days of hospitalization. During index emergency department visits, patients were symptomatic (New York Heart Association), aged median of 70 years (Interquartile range (IQR) 18), 59% ( = 103) were male, predominantly White (73%, = 128), and had a high Charleston Comorbidity index score [5, IQR (4-7)]. Nearly one-fourth (23%, = 41) of the patients had <3.5 g/dL albumin levels. The median length of hospital stay was eight days (IQR of 11). Comparing differences between lengths of hospital stays (8 vs. >8 days), there was different serum albumin (3.9 0.48 vs. 3.6 0.53, < .001) and left ventricular ejection fraction (45% (range 26-63) versus 30% (range 24-48), = .004). An increased serum albumin decreased prolonged hospitalization (odds ratio (OR), 0.28; 95% confidence interval (CI), 0.14-0.55, = <0.001). Patients in the lower albumin group had higher NT-proBNP (median: 8521 (range 2025-9134) versus 5147 (range 2966-14,795) pg/ml, = .007) and delay in administering intravenous diuretics (391 (167-964) minutes versus 271 (range 157-533) minutes, = .02). Hypoalbuminemia is strongly associated with prolonged hospitalization. Timely and effective diuretic therapy may reduce hospital stay durations, particularly with albumin supplementation.
白蛋白在提高渗透压和血液动力学方面起着至关重要的作用。血清白蛋白水平较低可能导致肺充血和水肿，并导致心肌功能障碍、利尿抵抗和急性心力衰竭时的液体潴留。我们假设血清白蛋白正常的急性心力衰竭患者的住院时间较短。使用电子病历，纳入 2020 年 5 月至 2021 年 5 月期间年龄>18 岁、ICD-10 和阳性弗雷明汉心力衰竭诊断标准的入院患者。我们排除了没有白蛋白记录和 eGFR 小于 30ml/min/1.73m 的患者。延长住院时间定义为>8 天的住院时间。在指数急诊科就诊时，患者有症状（纽约心脏协会），年龄中位数为 70 岁（四分位距（IQR）18），59%（=103）为男性，主要为白人（73%，=128），Charleston 合并症指数评分较高[5，IQR（4-7)]。近四分之一（23%，=41）的患者白蛋白水平<3.5g/dL。中位住院时间为 8 天（IQR 为 11）。比较住院时间（8 天与>8 天）的差异，血清白蛋白不同（3.90.48 与 3.60.53，<.001）和左心室射血分数不同（45%（范围 26-63）与 30%（范围 24-48），<.001）。血清白蛋白升高可减少延长的住院时间（优势比（OR），0.28；95%置信区间（CI），0.14-0.55，<.001）。白蛋白水平较低的患者 NT-proBNP 更高（中位数：8521（范围 2025-9134）与 5147（范围 2966-14795）pg/ml，<.007）和静脉利尿剂给药延迟（391（167-964）分钟与 271（范围 157-533）分钟，<.02）。低白蛋白血症与延长住院时间密切相关。及时有效的利尿治疗可能会缩短住院时间，特别是补充白蛋白。
