Serum albumin is a useful prognostic indicator and adds important information to NT-proBNP in a Chinese cohort of heart failure

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Abstract

Objective

To evaluate the effect of serum albumin on prognosis and the power of albumin adding information to NT-proBNP in a Chinese cohort of heart failure.

Design and methods

385 consecutive patients (male vs. female: 292 vs. 93; mean age: 54.89 ± 14.41 years; NYHA classes II–V) admitted for heart failure exacerbation with LVEF  45% were enrolled, and biochemical data was measured at baseline. The endpoint was defined as cardiac death or rehospitalization for aggravated heart failure. Follow-up period was 25 ± 7 months.

Results

Multivariate analysis in a Cox proportional hazard model revealed serum albumin was an independent predictor for adverse prognosis (HR 0.96,CI 0.94–0.99, P = 0.02), and the patients with higher NT-proBNP and lower albumin than median had the highest risk for cardiac events (HR 2.89, CI 1.90–4.40, P < 0.01).

Conclusion

Serum albumin is a significant prognosis indicator for heart failure and it adds important information to NT-proBNP.

Highlights

► Serum albumin on prognosis of Chinese heart failure population firstly testified. ► Serum albumin was an independent prognosis indicator for this cohort. ► Serum albumin adds important prognosis information to NT-proBNP.

Introduction

Hypoalbuminemia has been reported as a manifestation of liver dysfunction secondary to chronic heart failure [1], [2], [3], [4]. Some reports indicated hypoalbuminemia was a risk factor for developing heart failure [5], [6], [7] and also a risk factor for worse prognosis of heart failure [8], [9]. However, the role of serum albumin in Chinese population with heart failure has not been well discussed. As a traditional biochemical index, whether albumin could provide additional prognosis information to amino terminal B-type natriuretic peptide (NT-proBNP), which has become an established biomarker in heart failure in recent years, has not been investigated. The main purpose of this study was to explore the effect of serum albumin on prognosis and its power in adding prognostic information to NT-proBNP in a Chinese cohort of heart failure.

Section snippets

Study population

Patients admitted to Fuwai Hospital (Beijing, China) for heart failure exacerbation, with left ventricular ejection fraction (LVEF) less than 45% (New York Heart Association (NYHA) classesII–IV), were consecutively enrolled from January 2009 to November 2010, irrespective of the cause. The diagnosis of heart failure exacerbation was made by two clinicians with wide experience, according to Framingham criteria in combination with echocardiography and X-ray presentation. In order to reduce the

Results

385 participants were consecutively enrolled in this study, of which 292 (75.84%) were male. The mean age of participants was 54.89 ± 14.41 years. The potential causes of heart failure were coronary artery disease (152, 39.48%), dilated cardiomyopathy (140, 36.36%), valvular disease (34, 8.83%), peripartum cardiomyopathy (10, 2.60%), hypertension (160, 41.56%), and diabetes mellitus (97, 25.19%). Other characteristics were listed in Table 1.

During the follow-up period (25 ± 7 months), cardiac events

Discussion

Liver function damage as a presentation of worsening hemodynamics in heart failure has received much attention for several years [12], [13], [14], [15], [16], [17]. A number of studies have discussed changes in liver function, which could predict the prognosis of heart failure. These studies mainly focused on one single liver function category, such as bilirubin [10], [18], AST, serum albumin [8], [9], ALT [19], and γ-GTP [20]. To the best of our knowledge, this is the first study to testify

Conclusion

Serum albumin concentration is a useful prognosis indicator, and it has the power of adding important prognostic information to NT-proBNP for this Chinese cohort of heart failure.

Acknowledgement

This study did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector. We are thankful to Rachel Drew for her invaluable help in preparing the manuscript.

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