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Addition of albumin to Traditional Risk Score Improved Prediction of Mortality in Individuals Undergoing Transcatheter Aortic Valve Replacement
Author(s) -
Grossman Yoni,
Barbash Israel M.,
Fefer Paul,
Goldenberg Ilan,
Berkovitch Anat,
Regev Ehud,
Fink Noam,
BenZekry Sagit,
Brodov Yafim,
Kogan Alexander,
Guetta Victor,
Raanani Ehud,
Segev Amit
Publication year - 2017
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.15070
Subject(s) - medicine , hazard ratio , confidence interval , albumin , valve replacement , proportional hazards model , serum albumin , prospective cohort study , surgery , cardiology , stenosis
Objectives The ability of the Society of Thoracic Surgeons ( STS ) and European System for Cardiac Operative Risk Evaluation (Euro SCORE )‐2 scores to predict outcomes after transcatheter aortic valve replacement ( TAVR ) is insufficient. Frailty and serum albumin as a frailty marker were shown to correlate with prognosis after TAVR . We sought to evaluate the additive value of serum albumin to STS and Euro SCORE ‐2 scores to predict mortality in individuals undergoing TAVR . Design Retrospective analysis. Setting Tertiary‐care hospital prospective registry. Participants Individuals who underwent TAVR (N = 426). Measurements We compared survival rates according to median baseline albumin levels (4 g/dL), STS score (4.5%), and EuroSCORE‐2 (3.45%). Participants were divided into four groups according to median serum albumin and median STS and Euro SCORE ‐2 scores (high vs low), and 1‐year survival rates were compared. A category‐free net reclassification index ( NRI ) was calculated to compare the ability of a model of STS or Euro SCORE ‐2 alone to classify mortality risk with and without the addition of baseline serum albumin. Results Participants with low albumin levels had higher mortality (hazard ratio ( HR ) = 3.03, 95% confidence interval ( CI ) = 1.66–5.26, P < .001). Participants with low serum albumin and a high STS ( HR = 4.55, 95% CI = 2.21–9.38, P < .001) or Euro SCORE ‐2 ( HR = 2.72, 95% CI = 1.48–5.06, P = .001) score had higher mortality. Using NRI analysis, a model that included albumin in addition to STS correctly reclassified 42% of events ( NRI = 0.58) and a model that included albumin in addition to Euro SCORE ‐2 correctly reclassified 44% of events ( NRI = 0.64). Conclusion Serum albumin, as a marker of frailty, can significantly improve the ability of STS and Euro SCORE ‐2 scores to predict TAVR ‐related mortality.