Li Ming-Hui, Liu Qing-Rong, Zhao Zhen-Yan, Xu Hai-Yan, Wu Yong-Jian
State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
Department of Cardiology, Beijing Aerospace General Hospital, Beijing, China.
J Geriatr Cardiol. 2025 Apr 28;22(4):423-432. doi: 10.26599/1671-5411.2025.04.003.
Low serum albumin levels are established predictors of adverse outcomes in various cardiovascular conditions. However, the role of serum albumin in mortality among elderly patients with chronic aortic regurgitation (AR) has not been thoroughly investigated. This study aims to assess the relationship between serum albumin levels and mortality in this specific patient population.
Our analysis included 873 elderly AR patients from the China Valvular Heart Disease study, with baseline serum albumin measured at enrollment. Mortality outcomes were monitored for two years post-enrollment, employing a Cox proportional hazards model with a two-piecewise Cox proportional hazards framework to investigate the nonlinear relationship between serum albumin levels and all-cause mortality.
During the 2-year follow-up period, we observed 63 all-cause deaths. The association between serum albumin levels and all-cause mortality displayed an approximating L-shaped curve, indicating a mortality threshold at 35 g/L. For serum albumin levels below 35 g/L, each 1 g/L decrease was associated with a 25% higher risk of all-cause mortality (HR = 1.25, 95% CI: 1.07-1.45). In contrast, no significant change in mortality risk was observed when serum albumin levels were greater than or equal to 35 g/L. Moreover, when serum albumin is classified as hypoproteinemia (serum albumin < 35 g/L), the higher risks of all-cause death were observed in hypoproteinemic patients (HR = 2.93, 95% CI: 1.50-5.74). More importantly, the association between serum albumin and death was significantly stronger in overweight/obese patients (≥ 24 kg/m < 24 kg/m, = 0.006).
In elderly patients with AR, serum albumin levels showed an approximating L-shaped relationship with all-cause death, with thresholds of 35 g/L. Body mass index was significant effect modifiers of the association. These results suggest that serum albumin, as an inexpensive and readily available biochemical marker, may further improve the stratified risk of mortality in older AR patients.
低血清白蛋白水平是多种心血管疾病不良预后的既定预测指标。然而，血清白蛋白在老年慢性主动脉瓣关闭不全（AR）患者死亡率中的作用尚未得到充分研究。本研究旨在评估这一特定患者群体中血清白蛋白水平与死亡率之间的关系。
我们的分析纳入了中国瓣膜性心脏病研究中的873例老年AR患者，在入组时测量了基线血清白蛋白。入组后对死亡率进行了两年的监测，采用Cox比例风险模型和两段式Cox比例风险框架来研究血清白蛋白水平与全因死亡率之间的非线性关系。
在2年的随访期内，我们观察到63例全因死亡。血清白蛋白水平与全因死亡率之间的关联呈现近似L形曲线，表明死亡率阈值为35g/L。对于血清白蛋白水平低于35g/L的情况，每降低1g/L，全因死亡率风险增加25%（HR=1.25，95%CI：1.07-1.45）。相比之下，当血清白蛋白水平大于或等于35g/L时，未观察到死亡率风险有显著变化。此外，当血清白蛋白被分类为低蛋白血症（血清白蛋白<35g/L）时，低蛋白血症患者的全因死亡风险更高（HR=2.93，95%CI：1.50-5.74）。更重要的是，血清白蛋白与死亡之间的关联在超重/肥胖患者（≥24kg/m²，P=0.006）中显著更强。
在老年AR患者中，血清白蛋白水平与全因死亡呈现近似L形关系，阈值为35g/L。体重指数是该关联的显著效应修饰因素。这些结果表明，血清白蛋白作为一种廉价且易于获得的生化标志物，可能进一步改善老年AR患者的死亡风险分层。
