Serum albumin and mortality in acutely decompensated heart failure

Background Although hypoalbuminemia has been associated with decreased survival in chronic systolic heart failure (HF), its role for prognosticating outcomes in those with acutely decompensated heart failure (ADHF) has not been established. Methods and Results 438 consecutive patients with ADHF (mean age 75 +/- 13 years, mean left ventricular ejection fraction 41% +/- 20%) admitted to a large community hospital were studied. The mean serum albumin level for the group was 3.4 g/dL; quintile analysis demonstrated an inflection of risk for death below this value. Patients with hypoalbuminemia (defined as a serum albumin <3.4 g/dL; N = 236, 54% overall) were more likely to have prior HF, more severe HF symptoms, more likely to be edematous, and had more prevalent prognostically meaningful laboratory abnormalities, such as a higher frequency of renal dysfunction and elevated B-type natriuretic peptide. Independent associations between anemia, hyponatremia, lack of therapy with vasodilators at presentation, prior history of obstructive airways disease, severe tricuspid regurgitation, low serum cholesterol, and the presence of a pleural effusion on chest radiography were found with reduced serum albumin; interestingly, body mass index was not predictive of albumin levels. In Cox proportional hazards analysis, hypoalbuminemia predicted 1-year mortality (hazard ratio [HR](adjusted) = 2.05, 95% CI 1.10-3.81, P = .001). Reduced serum albumin concentrations were prognostic across a wide range of body mass index but had highest HR in obese patients (HRadjusted = 4.39 [95% CI = 1.66 to 11.60], P = .003). As well, hypoalbuminemia was mainly predictive of outcomes among those with systolic HF (HRadjusted = 5.00, 95% CI = 2.17-11.5, P < .001). Conclusion Hypoalbuminemia is common among patients with ADHF and is independently associated with increased one year mortality in patients admitted with ADHF. (Am Heart J 2010;160:1149-55.)