Patients with heart failure and concomitant hypoalbuminemia face higher in-patient mortality risk

"Patients admitted with HF and concomitant HA were nearly twice the odds of in-patient mortality than those with normal albumin levels," Sadichhya Karki, Department of Internal Medicine, John H. Stroger Jr Hospital of Cook County, and colleagues reported. "The length of stay (LOS) was higher between comparison groups."

Albumin is a protein produced by the liver and is vital for regulating fluid balance and maintaining blood volume. Low albumin levels in the blood characterize Hypoalbuminemia. Also, it is a marker of malnutrition-inflammatory syndrome. Various studies have shown its prognostic role in patients with chronic HF. However, data is scarce regarding hypoalbuminemia in acute heart failure admissions. Therefore, Karki and the team aimed to analyze the relationship between hypoalbuminemia and heart failure.

For this purpose, the researchers used a retrospective cohort study surveying data from the 2016-2018 combined NIS (National Inpatient Sample) database. Using the ICD-10 codes, they identified adult hospitalizations for heart failure patients and stratified them into cohorts with and without hypoalbuminemia.

The study's primary outcomes were the length of stay, in-patient mortality and total hospital charge. HF admissions with hypoalbuminemia were also reclassified to those with diastolic or systolic heart failure to compare any differences in mortality and other in-patient complications—multivariate linear and logistic regression to analyze the outcomes and adjust for confounders.

The authors reported the following findings:

• There were 1,365,529 adult hospitalizations for CHF, and among them, 88 % had secondary diagnoses of hypoalbuminemia.
• Patients with comorbid hypoalbuminemia were, on average, eight years older, predominantly white race, and males.
• HF hospitalizations with hypoalbuminemia had double in‐hospital mortality than those without (4.8% versus 2.7%).
• There was no difference in mortality between patients with SHF and DHF with concomitant low albumin levels (from 4.9 % vs. 4.7%).

"We found clinical outcomes among patients with HF and hypoalbuminemia to be worse than those without hypoalbuminemia," the researchers wrote. "Our data showed no statistically significant difference in mortality among systolic heart failure (SHF) compared to diastolic heart failure (DHF) associated with low albumin levels."

Also, they found increased odds of secondary adverse clinical outcomes, including sepsis, transfusion requirement, and acute kidney injury (AKI).

Reference:

Karki, S., Gajjar, R., Bittar- Carlini, G., Jha, V., & Yadav, N. (2023). Association of Hypoalbuminemia With Clinical Outcomes In Patients Admitted With Acute Heart Failure. Current Problems in Cardiology, 101916. https://doi.org/10.1016/j.cpcardiol.2023.101916