The role of nutritional status, measured by serum albumin, as a prognostic factor in wild-type transthyretin amyloidosis

BACKGROUND: Nutritional status is a recognised prognostic factor across various diseases, with serum albumin commonly used as a surrogate marker. However, its role in wild-type transthyretin cardiac amyloidosis (ATTRwt) remains underexplored. We aimed to assess the prognostic value of serum albumin at diagnosis in patients with ATTRwt. METHODS: Retrospective cohort study of ATTRwt patients included in an institutional registry between 2008 and 2023. Serum albumin was measured at diagnosis. The primary outcome was two-year all-cause mortality. A receiver operating characteristic (ROC) curve was used to identify the optimal albumin cut-off. Patients were stratified accordingly, and survival analysis was performed using Kaplan-Meier curves and Cox regression models adjusted for clinically relevant variables. In multivariable analysis adjusted for age, NT-proBNP, and heart failure at diagnosis, low serum albumin and heart failure remained independently associated with the outcome. CONCLUSION: Lower serum albumin levels were associated with a higher incidence of all-cause mortality in patients with ATTRwt, underscoring the prognostic value of nutritional status in this population.