Association of albumin-bilirubin grade with short- and long-term mortality in patients with heart failure: a cohort study using restricted cubic splines and propensity score matching.

OBJECTIVE

Heart failure (HF) is a chronic progressive syndrome caused by a variety of cardiovascular diseases and is associated with high morbidity, mortality, and healthcare burden. Forecasting the prognosis of HF patients at an early stage is important. Therefore, our objective was to explore the relationship between HF patients' prognosis and the albumin-bilirubin (ALBI) grade.

METHODS

Data for the study were obtained from the MIMIC database. Patients with ALBI grade 1 were matched to patients with ALBI grades 2 and 3 using propensity score matching (PSM). Post-matching analyses were performed using Cox proportional hazards models, Kaplan-Meier survival analysis, restricted cubic splines (RCS), and subgroup analyses.

RESULTS

RCS analyses revealed a nonlinear relationship between ALBI grade and 30-, 90-, and 360-day mortality in patients with HF, with a threshold value identified at -1.92. When ALBI scores were below - 1.92, the risk of mortality in HF patients remained relatively stable. In contrast, as ALBI scores approached and exceeded - 1.92, the mortality risk increased rapidly. Before PSM, both ALBI grades 2 and 3 were independent predictors of mortality in patients with HF; however, after PSM, ALBI grade 2 was not statistically associated with patient mortality. This result was supported by Kaplan-Meier (K-M) analysis.