Moayedifar Roxana, Celik Muhammed, Karner Barbara, Schaefer Anne-Kristin, Al Asadi Hebe, Marko Christiane, Ruoff Lukas, Zimpfer Daniel, Riebandt Julia, Schlöglhofer Thomas
Department of Cardiac and Aortic Thoracic Surgery, Medical University Vienna, 1090 Vienna, Austria.
Center for Medical Physics and Biomedical Engineering, Medical University Vienna, 1090 Vienna, Austria.
J Clin Med. 2025 Sep 2;14(17):6193. doi: 10.3390/jcm14176193.
: Preoperative hypoalbuminemia is a known risk factor for adverse outcomes in cardiac surgery, but its role in patients undergoing HeartMate 3 (HM3) left ventricular assist device (LVAD) implantation is unclear. This study evaluated the association between albumin levels and postoperative outcomes, aiming to define a clinically meaningful cut-off for risk stratification. : We retrospectively analyzed 205 adult patients who underwent HM3 implantation at a single center from June 2014 to December 2023. Receiver operating characteristic (ROC) analysis identified an optimal pre-implant albumin cut-off of <32 g/L. This threshold, derived using the maximal Youden Index, provided a sensitivity of 52.1%, specificity of 71.6%, and an AUC of 0.64 (95% CI 0.56-0.71), with internal bootstrapping validation confirming model stability, and calibration demonstrating good agreement between predicted and observed outcomes. Kaplan-Meier analysis assessed freedom from hemocompatibility-related adverse events (HRAEs) and survival. Cox proportional hazards models evaluated albumin and other variables as independent risk factors for HRAEs. : Patients with pre-implant albumin <32 g/L had higher rates of HRAEs, including stroke (24.9% vs. 8.4%, = 0.004) and bleeding (38.1% vs. 23.2%, = 0.012). Freedom from HRAEs was significantly lower in the hypoalbuminemia group (45.2% vs. 69.8%, < 0.001) and competing risk-adjusted cumulative incidence for HRAE was higher, but did not reach statistical significance ( = 0.11), one-year HRAE-free survival was also reduced (68.5% vs. 85.7%, = 0.03). In multivariable analysis, low albumin (HR 0.56, 95% CI 0.33-0.93, = 0.026) and temporary right ventricular assist device (RVAD) support (HR 3.32, 95% CI 2.05-5.39, < 0.001) were independent predictors of HRAEs. : Low preoperative albumin is independently associated with increased HRAEs and reduced one-year survival after HM3 implantation. Compared with the traditional 35 g/L threshold, the ROC-derived 32 g/L cut-off offered superior balance between sensitivity and specificity, underscoring its clinical utility. Albumin may serve as a simple, pragmatic, and cost-effective biomarker for preoperative risk assessment and optimization.
术前低白蛋白血症是心脏手术不良结局的已知危险因素，但其在接受HeartMate 3（HM3）左心室辅助装置（LVAD）植入的患者中的作用尚不清楚。本研究评估了白蛋白水平与术后结局之间的关联，旨在确定一个具有临床意义的风险分层临界值。我们回顾性分析了205例2014年6月至2023年12月在单一中心接受HM3植入的成年患者。受试者工作特征（ROC）分析确定植入前白蛋白的最佳临界值<32 g/L。该阈值通过最大约登指数得出，敏感性为52.1%，特异性为71.6%，曲线下面积（AUC）为0.64（95%可信区间0.56 - 0.71），内部自抽样验证证实了模型的稳定性，校准显示预测结果与观察结果之间具有良好的一致性。Kaplan-Meier分析评估了无血液相容性相关不良事件（HRAEs）的情况和生存率。Cox比例风险模型将白蛋白和其他变量评估为HRAEs的独立危险因素。植入前白蛋白<32 g/L的患者发生HRAEs的比率更高，包括中风（24.9%对8.4%，P = 0.004）和出血（38.1%对23.2%，P = 0.012）。低白蛋白血症组无HRAEs的情况显著更低（45.2%对69.8%，P < 0.001），HRAE的竞争风险调整累积发病率更高，但未达到统计学意义（P = 0.11），一年无HRAE生存率也降低（68.5%对85.7%，P = 0.03）。在多变量分析中，低白蛋白（风险比[HR] 0.56，95%可信区间0.33 - 0.93，P = 0.026）和临时右心室辅助装置（RVAD）支持（HR 3.32，95%可信区间2.05 - 5.39，P < 0.001）是HRAEs的独立预测因素。术前低白蛋白与HM3植入后HRAEs增加和一年生存率降低独立相关。与传统的35 g/L阈值相比，ROC得出的32 g/L临界值在敏感性和特异性之间提供了更好的平衡，强调了其临床实用性。白蛋白可作为术前风险评估和优化的一种简单、实用且具有成本效益的生物标志物。
