Hypoalbuminemia as a Prognostic Factor in Patients Admitted to a Tertiary Care Intensive Coronary Care Unit

Introduction: Hypoalbuminemia is common among acute and chronic diseases. It has been proposed as a potential biomarker of frailty, which itself is associated with worse outcomes in hospitalized and critically ill patients. However, data regarding hypoalbuminemia in intensive coronary care unit (ICCU) patients is scarce.

Material and methods: All patients admitted to the ICCU at Shaare Zedek Medical Center between January 1 and December 31, 2020 were included in the study. Patients were divided into 3 groups according to their basic albumin level. Low albumin level < 3 g/dL, intermediate albumin level 3 g/dL≤ albumin ≤ 4 g/dL and high albumin level >4 g/dL. 1-year Survival, in-hospital interventions and complications were compared.

Results and discussion: Overall 1,082 consecutive patients were included, mean age was 67 (±16) and 70% were males. Of them 8% had low albumin level, 71% had intermediate albumin level and 20% had high albumin level. As compared with intermediate and high albumin levels, low albumin level was associated with higher rate of bleeding (11.4%, 6% & 1.4%, respectively, p=0.002); sepsis (5.7%, 1.2% & 1%, respectively, p=0.004); mechanical ventilation (20.5%, 4.9% & 4.3%, respectively, p<0.0001); use of intra-aortic balloon pump (9.1%, 1.9% & 0.5%, respectively, p<0.0001) and cardiopulmonary resuscitation (14.8%, 1.9% & 0.5%, respectively, p<0.001). A multivariate Cox proportional hazards analysis found that low albumin level was independently associated with increased mortality risk as compared with high albumin level (HR=9.5; 95% CI: 3.2-25.5, p<0.001) as shown in Figure 1. Intermediate albumin level as compared with high albumin level, had a trend towards increased mortality risk, although it did not reach statistical significance (HR=2.1; 95% CI: 0.9-5.6, p=0.09).

Conclusion: As with other morbid conditions, hypoalbuminemia< 3 g/dL in ICCU patients is a poor prognostic factor of in-hospital morbidity and complications and for mortality during the first year of hospitalization.