Llàcer Pau, Croset François, de la Espriella Rafael, García Marina, Miñana Gema, Campos Jorge, Santas Enrique, Pérez Carlos, Lorenzo Miguel, Pérez Alberto, Núñez Gonzalo, Pérez Esteban, Manzano Luis, Núñez Julio
Internal Medicine Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Department of Medicine and Medical Specialties, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, IRYCIS, Madrid, Spain.
Internal Medicine Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain; Department of Medicine and Medical Specialties, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, IRYCIS, Madrid, Spain.
Eur J Intern Med. 2025 Mar;133:71-77. doi: 10.1016/j.ejim.2024.12.024. Epub 2025 Jan 3.
Hypoalbuminemia is frequently found in patients with heart failure (HF), associated with higher morbimortality in acute HF (AHF). Moreover, Carbohydrate Antigen 125 (CA125) is elevated in most of the AHF patients. In this cohort of patients admitted for AHF, our objective was to evaluate the association between hypoalbuminemia and long-term outcomes, including mortality and HF readmissions, stratified by CA125 concentration.
This is a retrospective observational study involving a derivation and a validation cohort of patients, included 1225 and 428 patients respectively, both cohorts of patients admitted for AHF, in two different hospitals. A variable with 4 categories was formed by combining albumin and CA125. The combined of 1-year all-cause mortality and unplanned HF rehospitalizations were selected as the main endpoints. Analysis was carried out by a Cox proportional hazard regression and p-value for interaction. The median (IQR) age was 77 (63-82) years, 514 (41.7 %) were women, 620 (50.2 %) had a preserved left ventricular ejection fraction. In the derivation cohort, after multivariate adjustment, the differential association of hypoalbuminemia according CA125 persisted significantly (p-value for interaction=0.036). Patients with hypoalbuminemia and CA125>35 U/ml confirmed identifying a subgroup at higher risk (HR: 1.35, CI 95 %=1.10-1.69, p = 0.009). Similar results were obtained in the validation cohort.
In patients with AHF, the prognostic impact of albumin is influenced by CA125 levels. Hypoalbuminemia was associated with higher risk of death or HF readmission only when coexisted with high CA125. On the contrary, when CA125 was low, hypoalbuminemia lacked prognostic effect.
低白蛋白血症在心力衰竭（HF）患者中很常见，与急性心力衰竭（AHF）的更高病残率和死亡率相关。此外，大多数AHF患者的糖类抗原125（CA125）升高。在这组因AHF入院的患者中，我们的目标是评估低白蛋白血症与长期预后之间的关联，包括死亡率和HF再入院率，并按CA125浓度进行分层。
这是一项回顾性观察性研究，涉及一个推导队列和一个验证队列的患者，分别包括1225例和428例患者，两个队列的患者均因AHF在两家不同医院入院。通过结合白蛋白和CA125形成一个有4个类别的变量。将1年全因死亡率和非计划HF再住院的合并结果作为主要终点。通过Cox比例风险回归和交互作用的p值进行分析。中位（IQR）年龄为77（63 - 82）岁，514例（41.7%）为女性，620例（50.2%）左心室射血分数保留。在推导队列中，经过多变量调整后，根据CA125的低白蛋白血症差异关联持续显著（交互作用的p值 = 0.036）。低白蛋白血症且CA125>35 U/ml的患者被证明确认属于高危亚组（HR：1.35，95%CI = 1.10 - 1.69，p = 0.009）。在验证队列中获得了类似结果。
在AHF患者中，白蛋白的预后影响受CA125水平影响。仅当与高CA125共存时，低白蛋白血症才与更高的死亡或HF再入院风险相关。相反，当CA125较低时，低白蛋白血症缺乏预后作用。
