Open AccessAssociation of an increase in serum albumin levels with positive 1-year outcomes in acute decompensated heart failure: A cohort study
Author(s) -
Takao Kato,
Takeshi Morimoto,
Yasutaka Inuzuka,
Yodo Tamaki,
Neiko Ozasa,
Etsuhide Yamamoto,
Yusuke Yoshikawa,
Takeshi Kitai,
Ryoji Taniguchi,
Moritake Iguchi,
Masashi Kato,
Mamoru Takahashi,
Toshikazu Jinnai,
Tomoyuki Ikeda,
Keisuke Nagao,
Toshiyuki Kawai,
Akihiro Komasa,
Ryusuke Nishikawa,
Yoshiaki Kawase,
Takashi Morinaga,
Mitsunori Kawato,
Yuta Seko,
Masayuki Shiba,
Mamoru Toyofuku,
Yutaka Furukawa,
Kenji Ando,
Kazushige Kadota,
Yukihito Sato,
Koichiro Kuwahara,
Takeshi Kimura
Publication year - 2020
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0243818
Subject(s) - medicine , hypoalbuminemia , quartile , hazard ratio , albumin , heart failure , confidence interval , acute decompensated heart failure , confounding , serum albumin , proportional hazards model , body mass index , gastroenterology , cardiology
Background Despite the prognostic importance of hypoalbuminemia, the prognostic implication of a change in albumin levels has not been fully investigated during hospitalization in patients with acute decompensated heart failure (ADHF). Methods Using the data from the Kyoto Congestive Heart Failure registry on 3160 patients who were discharged alive for acute heart failure hospitalization and in whom the change in albumin levels was calculated at discharge, we evaluated the association with an increase in serum albumin levels from admission to discharge and clinical outcomes by a multivariable Cox hazard model. The primary outcome measure was a composite of all-cause death or hospitalization for heart failure. Findings Patients with increased albumin levels (N = 1083, 34.3%) were younger and less often had smaller body mass index and renal dysfunction than those with no increase in albumin levels (N = 2077, 65.7%). Median follow-up was 475 days with a 96% 1-year follow-up rate. Relative to the group with no increase in albumin levels, the lower risk of the increased albumin group remained significant for the primary outcome measure (hazard ratio: 0.78, 95% confidence interval: 0.69–0.90: P = 0.0004) after adjusting for confounders including baseline albumin levels. When stratified by the quartiles of baseline albumin levels, the favorable effect of increased albumin was more pronounced in the lower quartiles of albumin levels, but without a significant interaction effect (interaction P = 0.49). Conclusions Independent of baseline albumin levels, an increase in albumin during index hospitalization was associated with a lower 1-year risk for a composite of all-cause death and hospitalization in patients with acute heart failure.