P896Low serum albumin: a significant predictor of increased mortality and cardiac related hospitalizations in patients with heart failure

Abstract

Background: Low serum albumin is associated with increasing age, inflammation and malnutrition and is common in patients with chronic heart failure (HF). It has been suggested that it may have an impact on clinical outcome. Purpose(s): To evaluate the effect of albumin levels on clinical outcome in patients with HF. Method(s): All patients with HF at a health maintenance organization were followed for cardiac-related hospitalizations and death. Result(s): A total of 5,779 HF patients were included in the study; Mean followup was 487 days; Mean serum albumin was 4.0 g/dL (3.7-4.2) and 9% of the patients had hypoalbuminemia (albumin<3.5 g/dL). Low albumin was associated with increasing age, women gender, lower body mass index, higher creatinine and urea but lower sodium, hemoglobin, iron and cholesterol. Low albumin was associated with increased CRP. Patients with hypoalbuminemia were treated less with ACE-I/ARB and beta blockers and more with furosemide. Hypoalbuminemia was associated with preserved LV ejection fraction, reduced RV function, severe tricuspid regurgitation and pulmonary hypertension. Cox regression analysis after adjustment for significant predictors demonstrated that decreasing quartiles of albumin was significantly associated with mortality: Lowest quartile compared to highest: HR 2.27, 95% CI 2.04-2.54, P<0.001. Cox regression analysis of albumin as a continuous parameter using restricted cubic splines after adjustment for significant parameters demonstrated that reduced albumin levels were directly associated with increased mortality (Figure). Decreasing quartiles of albumin were also a significant predictor of increased cardiac-related hospitalizations. Conclusion(s): Hypoalbuminemia is a significant predictor of a worse outcome in HF and is an ominous sign in patients with HF.