Underweight status increased 5-year all-cause mortality compared to normal weight (HR 2.42) after surgical aortic valve replacement, with low serum albumin further stratifying risk in this group.
Cohort (n=774)
Yes
Does underweight status and low serum albumin predict all-cause mortality in patients undergoing surgical aortic valve replacement?
Low BMI and low serum albumin are independent predictors of higher all-cause mortality in patients undergoing surgical aortic valve replacement, providing a useful tool for risk stratification.
Effect estimate: HR 2.42 (95% CI 1.25-4.69)
Absolute Event Rate: 23.5% vs 11.9%
p-value: p=0.016
OBJECTIVE: The clinical impact of underweight on outcomes in patients undergoing surgical aortic valve replacement (SAVR) remains unclear. This study aimed to investigate the prognostic significance of underweight status in patients undergoing SAVR and to identify key determinants of adverse outcomes within this population. METHODS: 805 patients underwent SAVR between January 2016 and December 2021 at eight Japanese centers. After excluding 31 patients with missing laboratory data, a total of 774 patients were included. Patients were categorized into underweight group (Body mass index BMI < 18.5 kg/m², 79 patients), normal-weight group (BMI 18.5-25 kg/m², 464 patients), and overweight group (BMI ≥25 kg/m², 231 patients). The primary endpoint was all-cause mortality. RESULTS: The median age was 76 years (interquartile range IQR: 71-79), and the median BMI was 23.3 kg/m² (IQR: 20.9-25.8). Underweight patients had the highest 5-year mortality, followed by normal-weight and overweight patients (23.5%, 11.9%, and 7.4%; p = 0.001). In multivariable analysis, BMI was an independent predictor of mortality (1.0 kg/m² increase, adjusted hazard ratio: 0.92; 95% confidence interval: 0.86 to 0.99; p = 0.020). Among underweight patients, serum albumin was independently associated with all-cause mortality (p = 0.002). Underweight patients were stratified by median albumin into low (< 4.0 g/dL, n = 43) and normal (≥ 4.0 g/dL, n = 36) groups, and 5-year mortality was higher in the low albumin group (34.1% vs. 12.6%, p = 0.015). CONCLUSIONS: Low BMI was associated with higher mortality after SAVR, and serum albumin provided additional risk stratification within underweight group.
Ohmori et al. (2026) conducted a cohort in Severe aortic stenosis (n=774). Underweight (BMI < 18.5 kg/m²) vs. Normal weight (BMI 18.5-25 kg/m²) was evaluated on All-cause mortality at 5 years (HR 2.42, 95% CI 1.25-4.69, p=0.016). Underweight status increased 5-year all-cause mortality compared to normal weight (HR 2.42) after surgical aortic valve replacement, with low serum albumin further stratifying risk in this group.