Low Serum Albumin: An Important Predictor of Increased Mortality and Cardiac Related Hospitalizations in Patients with Heart Failure

Background: Low serum albumin is associated with increasing age, inflammation and malnutrition and is common in patients with chronic heart failure. It may have an impact on outcome. We evaluated the effect of albumin levels on clinical outcome in patients with HF.

Methods: All patients with a diagnosis of HF at a health maintenance organization were evaluated. Patients were followed for cardiac related hospitalizations and death.

Results: 5,779 HF patients were included. Mean follow-up was 487 days; Mean serum albumin was 4.0 (3.7-4.2) and 9% of the patients had hypoalbuminemia. 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.

Conclusions: Hypoalbuminemia is a significant predictor of a worse outcome in HF and is an ominous sign in these patients.