Pre-procedural serum albumin predicts length of hospital stay and death among TAVR patients
A 50% death rate for severe AS at two years after diagnosis exists in the absence of treatment. For many years, surgical aortic valve replacement was the only interventional treatment for severe AS (SAVR). Although SAVR has been linked to an intraoperative mortality rate as high as 10% for patients with advanced age, left ventricular failure, and chronic renal illness, it also necessitates sternotomy and cardiac bypass.
As a result, surgery was historically not provided to approximately one third of individuals with severe AS. Percutaneous transcatheter aortic valve replacement (TAVR) has been created and improved during the last 20 years in an effort to lower peri-procedural morbidity and mortality in high-risk patients. According to recently released data, individuals with pre-procedural albumin values below 3.5 g/dL are more likely to have negative outcomes after TAVR than patients with albumin concentrations over 3.5 g/dL.
Data from TAVR patients at the author's facility between January 2013 and December 2017 were retrospectively evaluated. One to four weeks before to the surgery, the baseline albumin concentration for each patient was measured. We conducted regression analyses, adjusting for Society of Thoracic Surgeons classification, New York Heart Association classification, and Kansas City Cardiomyopathy Questionnaire 12 scores, to look at the relationship between albumin concentration and outcomes.
In the analysis, 338 patients were accounted for. According to Cox-proportional hazards regression, patients with albumin concentrations below 3.5 g/dL were 80% more likely to have an extended length of stay in the ICU. in comparison to patients with albumin concentrations >3.5 g/dL (HR 1.79; 95%CI 1.04-2.57, P = 0.03) and 70% more likely to have a protracted hospital stay (HR 1.68; 95%CI 1.01-2.46, P = 0.04). When compared to patients with albumin concentrations >3.5 g/dL, logistic regression revealed that patients with albumin concentrations 3.5 g/dL were four times more likely to not live to 90 days (OR 3.94; 1.13-12.63, P = 0.03) following their TAVR.
In this single-center, retrospective study, we demonstrate that, compared to patients with normal albumin concentrations (3.5 g/dL), TAVR patients with low pre-procedural albumin concentrations (3.5 g/dL) have a higher risk of prolonged ICU and hospital LOS, a fivefold risk of non-home discharge, and a fourfold risk of 90-day mortality. Although our study's findings are observational in nature, it is impossible to dispute their biological validity. Patients with chronic diseases may have low albumin concentrations as a biomarker for cachexia. Patients with severe cardiovascular illness are susceptible to the syndrome known as cardiac cachexia, which is more common in those with heart failure. It has been proposed that anorexia as well as an imbalance between anabolic and catabolic pathways, up-regulation of the renin-angiotensin axis, neurohormonal abnormalities, and inflammation play a significant part in its etiology. As a result, pre-procedural albumin concentrations may aid to identify prospective TAVR candidates who may benefit from stronger preventative efforts and are at elevated risk for malnutrition and/or cachexia. According to the current data, patients with low pre-procedural albumin concentrations may have longer hospital and ICU stays, be more likely to be discharged away from home, and have a greater probability of dying within 90 days following TAVR than patients with normal pre-procedural albumin concentrations. To ascertain if risk categorization based on pre-procedural albumin concentration will enhance outcomes in potential TAVR patients, prospective trials are required.
Reference –
Beydoun NY, Tsytsikova L, Han H, Furzan A, Weintraub A, Cobey F, Quraishi SA. Pre-procedural serum albumin concentration is associated with length of stay, discharge destination, and 90-day mortality in patients after transcatheter aortic valve replacement. Ann Card Anaesth 2023;26:72-7
