What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Heart failure (n=44048). Intervention: Hypoalbuminemia vs. Normal serum albumin. Primary outcome: In-hospital mortality in acute heart failure (OR 3.77, 95% CI 1.96-7.23, p=<0.001).

March 12, 2021Open Access

Prognostic role of albumin level in heart failure

Q: What are the key findings of this study?

Hypoalbuminemia in patients with acute heart failure was associated with an almost four-fold increased risk of in-hospital mortality (OR 3.77) compared to normal albumin levels.

Key Result

Hypoalbuminemia in patients with acute heart failure was associated with an almost four-fold increased risk of in-hospital mortality (OR 3.77) compared to normal albumin levels.

Study Design

Type

Meta-Analysis (n=44,048)

Structured PICO

Does hypoalbuminemia predict increased mortality and rehospitalization in patients with heart failure?

Population

44,048 patients with heart failure from 48 studies were included to evaluate the prognostic role of hypoalbuminemia on in-hospital and long-term mortality.

Exposure

Hypoalbuminemia (HA) or lower serum albumin levels

Comparator

Normal serum albumin levels

Outcome

All-cause mortality (in-hospital and long-term post-discharge)hard clinical

Hypoalbuminemia is a widely available and affordable biomarker that strongly predicts in-hospital and long-term mortality in patients with heart failure, with predictive accuracy comparable to BNP.

Main Result

Odds Ratio: 3.77 (95% CI 1.96–7.23)

p-value: p=<0.001

Limitations

Only 9 out of the 48 studies used a prospective design
Half of the included studies did not adequately address relevant confounders in their multivariate analysis
Significant heterogeneity between included studies
Only 44% of the included papers were designed to evaluate the effect of hypoalbuminemia on heart failure outcomes
Odds ratio (OR) was used to denote both OR and hazard ratio (HR), which might have introduced bias

Abstract

BACKGROUND: Hypoalbuminemia (HA) is common in HF, however, its pathophysiology and clinical implications are poorly understood. While multiple studies have been published in the past decade investigating the role of serum albumin in HF, there is still no consensus on the prognostic value of this widely available measure. The objective of this study is to assess the prognostic role of albumin in heart failure (HF) patient. METHODS: Unrestricted searches of MEDLINE, EMBASE, Cochrane databases were performed. The results were screened for relevance and eligibility criteria. Relevant data were extracted and analyzed using Comprehensive Meta-Analysis software. The Begg and Mazumdar rank correlation test was utilized to evaluate for publication bias. RESULTS: A total of 48 studies examining 44,048 patients with HF were analyzed. HA was found in 32% (95% confidence interval CI 28.4%-37.4%) HF patients with marked heterogeneity (I2 = 98%). In 10 studies evaluating acute HF, in-hospital mortality was almost 4 times more likely in HA with an odds ratios (OR) of 3.77 (95% CI 1.96-7.23). HA was also associated with a significant increase in long-term mortality (OR: 1.5; 95% CI: 1.36-1.64) especially at 1-year post-discharge (OR: 2.44; 95% CI: 2.05-2.91; I2 = 11%). Pooled area under the curve (AUC 0.73; 95% CI 0.67-0.78) was comparable to serum brain natriuretic peptide (BNP) in predicting mortality in HF patients. CONCLUSION: Our results suggest that HA is associated with significantly higher in-hospital mortality as well as long-term mortality with a predictive accuracy comparable to that reported for serum BNP. These findings suggest that serum albumin may be useful in determining high-risk patients.

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