Serum albumin is a useful prognostic indicator and adds important information to NT-proBNP in a Chinese cohort of heart failure
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.
References (37)
- et al.
Serum albumin concentration and heart failure risk The Health, Aging, and Body Composition Study
Am Heart J
(2010) - et al.
Usefulness of serum albumin concentration for in-hospital risk stratification in frail, elderly patients with acute heart failure. Insights from a prospective, monocenter study
Int J Cardiol
(2008) - et al.
Albumin levels predict survival in patients with systolic heart failure
Am Heart J
(2008) - et al.
Chromogranin A and C-terminal endothelin-1 precursor fragment add independent prognostic information to amino-terminal proBNP in patients with acute destabilized heart failure
Clin Chim Acta
(2009) - et al.
Type of liver dysfunction in heart failure and its relation to the severity of tricuspid regurgitation
Am J Cardiol
(2002) - et al.
Abnormal liver function in relation to hemodynamic profile in heart failure patients
J Card Fail
(2010) - et al.
Gamma-glutamyltransferase rather than total bilirubin predicts outcome in chronic heart failure
J Card Fail
(2011) - et al.
Serum albumin and mortality in acutely decompensated heart failure
Am Heart J
(2010) - et al.
Blood volume in congestive heart failure as determined with iodinated human serum albumin
Am Heart J
(1954) - et al.
The antioxidant properties of serum albumin
FEBS Lett
(2008)
Human serum albumin in the clinical syndrome of heart failure
J Card Fail
The importance of abnormalities of liver function tests in predicting mortality in chronic heart failure
Eur Heart J
Some observations on liver function in heart failure
Edinb Med J
Liver function in congestive heart failure
J Clin Invest
Liver function in congestive heart failure
Taehan Naekwa Hakhoe Chapchi
Hypoalbuminemia as a risk factor of incident heart failure in the elderly
Am Heart J
Fibrinogen, lipoprotein (a), albumin and bilirubin (F-L-A-B) levels and cardiovascular risk calculated using the Framingham equation
In Vivo
Prognostic significance of increased serum bilirubin levels coincident with cardiac decompensation in chronic heart failure
Circ J
Cited by (22)
Does hypoalbuminemia contribute to the worsening of heart failure?
2020, Annales de Cardiologie et d'AngeiologieSerum albumin and cardiovascular disease: State-of-the-art review
2020, Annales de Cardiologie et d'AngeiologieCitation Excerpt :Albumin predicts outcome independent of usual prognostic markers such as age, renal failure or anemia. Significantly, hypoalbuminemia predicts outcome independent of body mass index, markers of inflammation, and liver function, both used as an indirect reflection of main causal factors of low serum albumin, in multivariate analysis [42,45–47,50]. Several studies have also reported the prognostic value of serum albumin independent of B-type natriuretic peptides [2,41–43,46,50,53].
Human serum albumin in cardiovascular diseases
2018, European Journal of Internal MedicineCitation Excerpt :Currently, large evidence is that hypoalbuminemia predicts adverse outcome independent of body mass index, inflammation and liver function used as markers of causal factors for low serum albumin levels [41,45–47]. In the observational study by Su et al. that included 385 patients with systolic heart failure followed for 25 months, low serum albumin concentration was linked to adverse outcome (p = 0.02), even after adjusting for body mass index (p = ns), inflammation (p = ns), liver function (p < 0.01) and B-type natriuretic peptides (p = 0.01) [41]. In the observational study by Bonilla-Palomas et al. that included 362 patients hospitalized for acute systolic and diastolic heart failure and followed for 20 months, hypoalbuminemia was a potent predictor of in-hospital death and long-term mortality (p = 0.04 and 0.02), even after adjusting for body mass index (p = ns and ns), nutritional status (p = ns and 0.03), C-reactive protein (p = ns and ns), liver function (p = ns and ns) and B-type natriuretic peptides (p = 0.003 and ns) [45].
Serum albumin and cardiovascular diseases: A comprehensive review of the literature
2018, Annales de Cardiologie et d'AngeiologieSerum albumin changes and multivariate dynamic risk modelling in chronic heart failure
2014, International Journal of CardiologyCitation Excerpt :Second, only blood tests were utilised for multivariate dynamic risk modelling as they are objective, reproducible and resistant to bias. Third, we lacked data on natriuretic peptides but albumin has been found to be prognostically independent of natriuretic peptides in other CHF studies [15,26]. Despite these limitations, our study has potentially important implications.
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Equal contribution.