Human Serum Albumin in the Clinical Syndrome of Heart Failure

Systemic inflammation-based Glasgow Prognostic Score as a prognostic indicator in chronic heart failure

Background

The Glasgow Prognostic Score (GPS), based on C-reactive protein and serum albumin concentrations provides useful prognostic information for patients with cancer or acute decompensated heart failure (HF). Herein, we aimed to evaluate the relationship between the GPS and long-term prognosis in patients with chronic HF.

Methods

In this large multicentre prospective observational study, part of the Chronic Heart Failure Analysis and Registry in the Tohoku District-2 (CHART-2) Study, we analysed the relationship between mortality and the GPS in 6,480 patients with chronic HF (mean age, 68 ± 13 years; 69 % male). Patients with elevated C-reactive protein levels (>1.0 mg/dL) and hypoalbuminaemia (<3.5 g/dL) received a GPS of 2; those with either received a GPS of 1, and those with neither received a GPS of 0.

Results

During median follow-up of 9.62 years, 2,564 patients (39.6 %) died. Increased GPS was associated with a significantly higher mortality risk in Kaplan-Meier analysis (log-rank P < 0.0001). This trend was consistent across sex, age, New York Heart Association class, HF stage and type, and cancer history. Adjusted Cox proportional hazards analysis showed the following hazard ratios for all-cause death, relative to a GPS of 0, 1.27 (95 % confidence interval, 1.13-1.44; P < 0.0001) for a GPS of 1 and 1.83 (95 % confidence interval, 1.45-2.32; P < 0.0001) for a GPS of 2. This increased risk was independent of B-type natriuretic peptide levels.

Conclusions

The GPS, which reflects systemic inflammation status, is a useful predictor of long-term prognosis in patients with chronic HF.

Prognostic Significance of Nutritional Scores in Patients With Heart Failure: Insights From the PARAGON-HF Trial

BACKGROUND

The Controlling Nutritional Status (CONUT) and Geriatric Nutritional Risk Index (GNRI) are indices that identify individuals at risk of malnutrition. Our study sought to examine the incidence and prognostic implications of abnormal CONUT and/or GNRI in patients with heart failure with preserved ejection fraction.

METHODS AND RESULTS

The CONUT score and GNRI were serially analyzed in this post hoc analysis of the PARAGON-HF (Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor With Angiotensin-Receptor Blockers Global Outcomes in Heart Failure With Preserved Ejection Fraction) trial. A CONUT score >2 or GNRI ≤98 was considered to be abnormal. The association between abnormal CONUT and/or GNRI (analyzed using a time-updated approach) and total heart failure hospitalizations and cardiovascular death was analyzed. Other outcomes included cardiovascular death, all-cause death, total heart failure hospitalizations, first all-cause hospitalization, and first noncardiovascular hospitalization. We also explored the effect of incident hospitalization on subsequent incident abnormal CONUT and/or GNRI. In 4794 patients (55% women, mean age 72±8 years), 1119 (23.3%) had at least 1 abnormal score at randomization. Among the remaining 3675 patients, 1405 (38.2%) developed at least 1 abnormal score over a median follow-up of 2.9 years. Any abnormal score during follow-up was associated with a significantly higher risk of fatal and nonfatal outcomes, and all types of hospitalizations (all-cause, heart failure, and noncardiovascular hospitalizations). Among patients with normal scores at randomization, any hospitalization during follow-up was associated with a significantly higher risk of developing at least 1 abnormal score posthospitalization, compared with prehospitalization and never-hospitalized patients (adjusted hazard ratio, 1.37 [95% CI, 1.22-1.55]).

CONCLUSIONS

Among patients with heart failure with preserved ejection fraction, the rate of individuals with abnormal CONUT and/or GNRI was high, especially following a heart failure hospitalization, and was linked with excess cardiovascular and noncardiovascular events.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: NCT01920711.

U-Shaped Relationship of Serum Albumin and Neurological Functional Outcomes After Acute Ischemic Stroke: A Prospective Cohort Study

INTRODUCTION

Several studies indicate that individuals with acute ischemic stroke (AIS) who have low levels of serum albumin (SA) have a dismal prognosis. However, intravenously administering albumin 25% at a dose of 2 g/kg did not lead to improved outcomes for patients with AIS after 90 days. Our objective was to examine the possible correlation between SA levels and stroke outcomes in a prospective cohort investigation.

METHODS

The research included a total of 5111 participants diagnosed with AIS. The correlation between SA level and modified Rankin Scale (mRS) scores 90 days after onset was examined via univariate and multivariate logistic analyses. The relationships were examined employing restricted cubic splines. An investigation was conducted to ascertain the connection between SA levels and neurological functional results by employing mediation analysis, with the mediation impact of low-density lipoprotein (LDL) taken into account. In addition, the subgroup analyses were performed using the logistic regression.

RESULTS

The connection between levels of SA and neurological functional outcomes following AIS exhibited a U-shaped pattern. The likelihood of a negative result dropped significantly with an elevation in SA (per g/L: OR (odds ratio) 0.88; 95% CI (confidence interval) 0.847-0.913) among individuals with SA levels below 42.2 g/L. Conversely, the likelihood of a negative outcome rose with an increase in SA (per g/L: OR 1.033, 95% CI 1.009-1.058) among people with SA levels of 42.2 g/L or above. Comparable findings were seen for mortality outcomes. A mediation study revealed that LDL had a mediating function in the statistical connection between SA levels and neurological functional outcomes, accounting for 12.3% of the connection. No significant interactions were seen in any of the groupings.

CONCLUSION

Among patients with AIS, there was a U-shaped relationship between SA levels at admission and the likelihood of poor outcomes, which was partially mediated by LDL. There is a Graphical Abstract available for this article.

Amino-Acid-Engineered Bionanozyme Selectivity for Colorimetric Detection of Human Serum Albumin

Nanozymes are emerging nanomaterials owing to their superior stability and enzyme-mimicking catalytic functions. However, unlike natural enzymes with inherent amino-acid-based recognition motifs for target interactions, manipulating nanozyme selectivity toward specific targets remains a major challenge. In this study, we introduce the de novo strategy using the supramolecular assembly of l-tryptophan (l-Trp) as the recognition amino acid with copper (Cu) ions for creating a human serum albumin (HSA)-responsive bionanozyme. This amino-acid-engineered bionanozyme enables selective colorimetric detection of HSA, a critical urinary biomarker for kidney diseases, overcoming the challenge that HSA is neither a typical substrate nor an inhibitor for most nanozymes. Kinetic studies and competitive tests reveal that HSA subdomain IIIA binding to l-Trp sites limits the electron-transfer-induced structural changes of l-Trp-Cu chelate rings, resulting in noncompetitive inhibition. This inhibition effect is significantly stronger than that observed for canonical amino acids, common proteins, and urinary interference species. Colorimetric monitoring of bionanozyme activity enables sensitive HSA detection with a detection limit of 1.3 nM and a quantification range of 2 nM to 10 μM. This approach is exceptionally more sensitive and offers a broader detection range compared to conventional colorimetric and fluorescent methods, suitable for diagnostics across various clinical stages of disease. This innovative rational strategy to designing and manipulating selective nanozyme-target interactions not only addresses the limitations of nanozymes but also expands their precise applications in complex biological systems.

Lower albumin levels are associated with 1-year mortality in older patients hospitalized for acute heart failure: THE ALBIMED-HF study

Hypoalbuminemia (i.e., albumin levels ≤ 3.5 g/dL) is a negative prognostic marker in several conditions, including acute heart failure (AHF). Hypoalbuminemia is common in patients hospitalized in Internal Medicine (IM) divisions. However, its role in predicting long-term mortality in AHF patients hospitalized in this setting is not clear. In THE ALBIMED-HF study, all patients hospitalized for AHF in the First Division of Internal Medicine at Ospedale di Circolo and Fondazione Macchi (ASST Sette Laghi, Varese, Italy) between January 1st and December 31st 2022 were retrospectively included. Clinical information was retrieved from patient electronic medical records. Four hundred and ninety-eight patients were considered for the present study (median age 85 [78-89] years). Median Charlson Comorbidity Index was 6 [5-7]. Heart failure (HF) with preserved ejection fraction was found in 40.6% of patients (N = 202/498). Median albumin levels were 3.2 [2.8-3.5] g/dL and hypoalbuminemia was recorded in 76.5% of patients (N = 381/498). At 12 months, 221 out of 498 patients (44.4%) died, and mortality was significantly higher in patients with hypoalbuminemia than in those without (N = 185/381 [48.6%] vs. N = 36/117 [30.8%], p < 0.001). Patients who died within 12 months were older, suffered more frequently from chronic kidney disease and active cancer, and exhibited higher C-reactive protein levels. At the multivariable analysis, hypoalbuminemia was independently associated with 12-month all-cause mortality (HR 2.41, 95% confidence interval 1.20-4.83). Hypoalbuminemia was independently associated with 12-month all-cause mortality in older patients with multiple comorbidities hospitalized for AHF in an IM division.

The impact of hypoalbuminemia on the long-term prognosis of patients with acute heart failure: The modifying role of carbohydrate antigen 125

AIMS

Hypoalbuminemia is frequently found in patients with heart failure (HF), associated with higher morbimortality in acute HF (AHF). Moreover, Carbohydrate Antigen 125 (CA125) is elevated in most of the AHF patients. In this cohort of patients admitted for AHF, our objective was to evaluate the association between hypoalbuminemia and long-term outcomes, including mortality and HF readmissions, stratified by CA125 concentration.

METHODS AND RESULTS

This is a retrospective observational study involving a derivation and a validation cohort of patients, included 1225 and 428 patients respectively, both cohorts of patients admitted for AHF, in two different hospitals. A variable with 4 categories was formed by combining albumin and CA125. The combined of 1-year all-cause mortality and unplanned HF rehospitalizations were selected as the main endpoints. Analysis was carried out by a Cox proportional hazard regression and p-value for interaction. The median (IQR) age was 77 (63-82) years, 514 (41.7 %) were women, 620 (50.2 %) had a preserved left ventricular ejection fraction. In the derivation cohort, after multivariate adjustment, the differential association of hypoalbuminemia according CA125 persisted significantly (p-value for interaction=0.036). Patients with hypoalbuminemia and CA125>35 U/ml confirmed identifying a subgroup at higher risk (HR: 1.35, CI 95 %=1.10-1.69, p = 0.009). Similar results were obtained in the validation cohort.

CONCLUSION

In patients with AHF, the prognostic impact of albumin is influenced by CA125 levels. Hypoalbuminemia was associated with higher risk of death or HF readmission only when coexisted with high CA125. On the contrary, when CA125 was low, hypoalbuminemia lacked prognostic effect.

Proposed Novel Heart Failure Biomarkers and Their Association with Length of Hospital Stay and Mortality: A Retrospective Observational Pilot Study

Background/Objectives: Chronic heart failure (CHF) remains a significant global health burden, with high morbidity, prolonged hospitalizations, and increased mortality. Traditional biomarkers such as NT-proBNP provide prognostic value; however, novel biomarker ratios may enhance risk stratification. This study evaluated the predictive utility of the NT-proBNP-to-albumin ratio (NTAR), red cell distribution width-to-eGFR ratio (RGR), and red cell distribution width-to-fibrinogen ratio (RFR) for hospital length of stay (LOS), extended hospitalization (ELOS), in-hospital mortality, and 6-month all-cause mortality. Methods: A retrospective observational pilot study was conducted on 382 CHF admissions (2022-2024) with comprehensive laboratory assessment. Biomarker performance was assessed through uni- and multivariate logistic regression, receiver operating characteristic curve, and Cox proportional hazards stepwise methods of analyses for refining predictive models. Results: NTAR and RGR emerged as significant predictors of hospitalization outcomes. NTAR demonstrated a moderate correlation with prolonged LOS (r = 0.45, p < 0.001) and was an independent predictor of ELOS (AUC = 0.697, OR = 2.438, p < 0.001), outperforming NT-proBNP. Additionally, NTAR significantly predicted in-hospital mortality (AUC = 0.768, OR = 4.461, p < 0.001) and 6-month all-cause mortality (AUC = 0.766, OR = 4.185, p < 0.001). RGR was the strongest predictor of in-hospital mortality (AUC = 0.785, HR = 2.18, p = 0.005), highlighting its role in renal dysfunction and erythropoietic alterations in CHF. The RFR observed prognostic value was minimal. Conclusions: In our study, NTAR and RGR offered valuable prognostic value underscoring the interplay of cardiac stress, nutritional status, and renal function in CHF prognosis. Further multicenter validation is warranted for these biomarkers.

Hs-CRP/ALB Levels Are Associated With Poor Long-term Prognosis in Patients With STEMI Undergoing Percutaneous Coronary Intervention

Research has explored the relationship between inflammatory biomarkers and cardiovascular diseases, highlighting the potential prognostic significance of the high-sensitivity C-reactive protein (hs-CRP)/albumin (ALB) ratio. However, it remains unclear whether this ratio is associated with adverse prognosis in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). This retrospective cohort study included 752 STEMI patients undergoing PCI at Tianjin Chest Hospital between January 2017 and December 2018. During a median follow-up of 52 months, 183 cases (24.0%) experienced major adverse cardiovascular events (MACE) events and 75 cases (10.0%) died. Cox regression analysis demonstrated that hs-CRP/ALB was independently associated with MACE as both a continuous (hazard ratio [HR] 1.152, 95% CI 1.097-1.210, P < .001) and categorical variable (HR 1.257, 95% CI 1.084-1.458, P = .027). Similar findings were observed for all-cause mortality (HR 1.119, 95% CI 1.058-1.183, P < .001; HR 2.228, 95% CI 1.009-4.920, P = .032). The receiver operating characteristic (ROC) curve indicated that hs-CRP/ALB levels have predictive capability for overall mortality in patients (the area under the curve [AUC] = 0.68). hs-CRP/ALB levels independently correlate with poor long-term prognosis in STEMI patients with prior PCI.

Red blood cell distribution width to albumin ratio is correlated with prognosis of patients in coronary care unit

BACKGROUND

As red blood cell distribution width (RDW) and albumin have been shown to be independent predictors of mortality from various diseases, this study aimed to investigate the effect of the RDW to albumin ratio (RA) as an independent predictor of the prognosis of patients admitted to the coronary care unit (CCU).

AIM

To use the RDW and albumin level to predict the prognosis of patients in the CCU.

METHODS

Data were obtained from the Medical Information Mart Intensive Care III database. The primary outcome was 365-day all-cause mortality, whereas the secondary outcomes were 30- and 90-day all-cause mortality, hospital length of stay (LOS), and CCU LOS. Cox proportional hazards regression model, propensity score matching, and receiver operating characteristic curve analyses were used.

RESULTS

The hazard ratio (95% confidence interval) of the upper tertile (RA > 4.66) was 1.62 (1.29 to 2.03) when compared with the reference (RA < 3.84) in 365-day all-cause mortality. This trend persisted after adjusting for demographic and clinical variables in the propensity score-matching analysis. Similar trends were observed for the secondary outcomes of hospital and CCU LOS. Receiver operating characteristic curve analysis was performed by combining the RA and sequential organ failure assessment (SOFA) scores, and the C-statistic was higher than that of the SOFA scores (0.733 vs 0.702, P < 0.001).

CONCLUSION

RA is an independent prognostic factor in patients admitted to the CCU. RA combined with the SOFA score can improve the predictive ability of the SOFA score. However, our results should be verified in future prospective studies.

Associations of Obesity and Prognostic Nutritional Index on 1-Year Mortality in Patients with Acute Heart Failure

Background

Increased BMI is paradoxically associated with improved survival among patients with acute heart failure (AHF). However, the impact of different nutritional status on this obesity paradox on 1-year mortality is underreported. The prognostic nutritional index is a simple tool to assess nutrition status.

Methods

From 10,027 emergency department admissions at the Amager and Hvidovre Hospital, Copenhagen University Hospital in Denmark, all patients with AHF were identified. Patients were categorised by BMI (normal: 18.5-24.9 kg/m2, overweight: 25-29.9 kg/m2, obese: ≥30 kg/m2) and nutritional status using the prognostic nutritional index (malnourished: <38, well-nourished: ≥38). Kaplan- Meier curves analysed cumulative survival, and Cox regression examined associations between BMI, nutritional status and outcomes, expressed as HR and 95% CI.

Results

Among 383 AHF patients (median age 76 years), 41.3% were malnourished and 58.7% well nourished. In the well-nourished group, obesity was inversely associated with 1-year mortality (adjusted HR 0.48; 95% CI [0.24-0.95]; p=0.035). However, this correlation disappeared in the malnourished group (adjusted HR 1.08; 95% CI [0.59-2.00]; p=0.798). Mortality rates were significantly lower in the well-nourished group among patients with overweight and obesity.

Conclusion

Obesity was associated with reduced 1-year mortality only in AHF patients with good nutritional status, while in malnourished patients, obesity was not associated with 1-year mortality. The prognosis in patients with AHF depends on both the presence of obesity and their nutritional status, highlighting the need for nutritional assessment for risk stratification.

Hypoalbuminaemia and heart failure: A practical review of current evidence

Hypoalbuminaemia (serum albumin levels ≤3.5 g/dl) is associated with poor outcomes among patients with heart failure (HF). This narrative review includes original articles and reviews published over the past 20 years and retrieved from PubMed using the following search terms (or their combination): 'heart failure', 'hypoalbuminaemia', 'heart failure with reduced ejection fraction', 'heart failure with preserved ejection fraction', 'all-cause mortality', 'in-hospital mortality', 'hospitalization', 'prognosis'. The aims of this review are to provide an overview on the prevalence of hypoalbuminaemia in HF, its impact on clinical outcomes, and potential mechanisms that may suggest future therapeutic strategies. Hypoalbuminaemia is frequent in HF patients, especially among the elderly. However, data about the exact epidemiology of hypoalbuminaemia are scant due to different definitions, and prevalence is estimated between 5% and 70% across the whole spectrum of ejection fraction. Current evidence points to hypoalbuminaemia as a marker of poor outcomes in HF, irrespective of the ejection fraction, and in other cardiovascular diseases. Among patients who suffered from acute coronary syndrome, those with hypoalbuminaemia had an increased risk of new-onset HF and in-hospital mortality. Albumin, however, might also play a role in the natural history of such diseases due to its antioxidant, anti-inflammatory, and antithrombotic properties. Whether albumin supplementation or nutritional support in general would be beneficial in improving clinical outcomes in HF is not completely clear and should be evaluated in adequately designed studies.

Prognostic value of the fibrinogen-to-albumin ratio (FAR) in patients with chronic heart failure across the different ejection fraction spectrum

The ratio of fibrinogen to albumin (FAR) is considered a new inflammatory biomarker and a predictor of cardiovascular disease risk. However, its prognostic value for patients with chronic heart failure (CHF) with different ejection fractions (EFs) remains unclear. A total of 916 hospitalized patients with CHF from January 2017 to October 2021 in the First Affiliated Hospital of Kunming Medical University were included in the study. Death occurred in 417 (45.5%) patients out of 916 patients during a median follow-up time of 750 days. Among these patients, 381 patients suffered from HFrEF (LVEF <40%) and 535 patients suffered from HFpEF or HFmrEF (HFpEF plus HFmrEF, LVEF ≥ 40%). Patients were categorized into high-level FAR (FAR-H) and low-level FAR (FAR-L) groups based on the optimal cut-off value of FAR (9.06) obtained from receiver operating characteristic (ROC) curve analysis. Upon analysing the Kaplan - Meier plots, the incidence of death was significantly higher in all patients with FAR-H and patients in both HF subgroups (p < 0.001). The multivariate Cox proportional hazard analyses indicated that the FAR was an independent predictor of all-cause mortality, regardless of heart failure subtype. (HR 1.115, 95% CI 1.089-1.142, p < 0.001; HFpEF plus HFmrEF, HR 1.109, 95% CI 1.074-1.146, p < 0.0001; HFrEF, HR 1.138, 95% CI 1.094-1.183, p < 0.0001) The optimal cut-off value of FAR in predicting all-cause mortality was 9.06 with an area under the curve value of 0.720 (95% CI: 0.687-0.753, p < 0.001), a sensitivity of 68.8% and a specificity of 65.6%. After adjusting for the traditional indicators (LVEF, Lg BNP, etc.), the new model with the FAR had better prediction ability in patients with CHF. Elevated FAR is an independent predictor of death in CHF and is not related to the HF subtype.

Longitudinal assessment of serum albumin levels with the risk of coronary artery calcification progression in an asymptomatic population of Korean adults: an observational cohort study

OBJECTIVES

This study evaluated the association between serum albumin levels and coronary artery calcification (CAC) progression in asymptomatic adults without hypoalbuminaemia at baseline.

DESIGN

Observational cohort study.

SETTING

Data from the Korea Initiatives on Coronary Artery Calcification (KOICA) which is a retrospective, single ethnicity, multicentre and observational registry were analysed.

PARTICIPANTS

A total of 12 344 Korean adults with baseline albumin level of ≥3.5 g/dL (51.7±8.5 years; 84.3% male) were included. The median interscan period was 3.0 (2.0-4.8) years. All participants were stratified into three groups based on serum albumin tertile.

PRIMARY AND SECONDARY OUTCOME MEASURES

Association of serum albumin with the risk of CAC progression was analysed using multivariate logistic regression models with adjustment of interscan period. CAC progression was defined as a square root (√) transformed difference between the baseline and follow-up coronary artery calcium score (CACS) (Δ√transformed CACS) of ≥2.5. Annualised Δ√transformed CACS was defined as Δ√transformed CACS divided by interscan period.

RESULTS

With increasing serum albumin tertiles, the annualised Δ√transformed CACS (I (lowest): 0.16 (0-1.24) vs II: 0 (0-1.09) vs III (highest): 0 (0-1.01)) and the incidence of CAC progression (I: 36.6% vs II: 31.3% vs III: 25.0%) were decreased despite higher prevalence of hypertension, diabetes and hyperlipidaemia (all p<0.05). Serum albumin levels were inversely related to the annualised Δ√transformed CACS and the risk of CAC progression among overall participants. After adjusting for age, sex, hypertension, diabetes, hyperlipidaemia, obesity, current smoking, alcohol consumption, serum creatinine levels, baseline CACS and interscan period, this inverse association between serum albumin levels (per-1 g/dL increase) and the risk of CAC progression was consistently observed, especially in baseline CACS of 1-10 (OR: 0.392, 95% CI: 0.234 to 0.658) and 11-100 (OR: 0.580, 95% CI: 0.381 to 0.883) (all p<0.05).

CONCLUSIONS

Serum albumin levels were inversely associated with the risk of CAC progression. This phenomenon was predominantly observed in CACS of 1-100 at baseline.

Combination of C-reactive protein and fibrinogen-to-albumin ratio as a novel predictor of all-cause mortality in heart failure patients

Heart failure (HF) is a common cardiovascular disease that is related to systemic inflammation. This study aimed to assess the role of C-reactive protein (CRP) combined with fibrinogen-to-albumin ratio (C-FAR) on the prognosis of all-cause mortality in different types of HF. A total of 1,221 hospitalized HF patients from the First Affiliated Hospital of Kunming Medical University between January 2017 and October 2021 were retrospectively analyzed. Patients were categorized into a low C-FAR group (C-FAR < 0.69) and a high C-FAR group (C-FAR ≥ 0.69) according to the median C-FAR value. We used Kaplan-Meier plots, restricted cubic spline regression, Cox survival analyses, and time-dependent receiver operating characteristic (ROC) analyses to evaluate the prognostic role of C-FAR on all-cause mortality in different types of HF. After excluding patients lost to follow-up and those with missing data, we ultimately included 1,196 patients with HF. The Kaplan-Meier plots showed that HF patients with high C-FAR levels had a significantly greater risk of all-cause mortality. In all four Cox proportional risk models, C-FAR was an independent predictor of all-cause mortality. Based on the ROC curve, the area under the curve (AUC) for C-FAR was greater than the AUC for Lg BNP. In the subgroup analyses, patients had the highest risk of all-cause mortality when FAR ≥ 0.091 and CRP ≥ 7.470. Regardless of the type of HF, C-FAR can be a good predictor of prognosis for all-cause mortality in HF patients, and patients with high C-FAR had a significantly increased risk of death compared to those with low C-FAR.

Are there etiology-specific risk factors for adverse outcomes in patients on Impella 5.5 support?

Objectives

To identify possible etiology-specific differences in preoperative risk factors for major adverse events during Impella 5.5 support in patients with ischemic (ICM) and nonischemic cardiomyopathy (NICM).

Methods

From October 2019 to January 2023, 228 Impella 5.5 devices were inserted at our institution. Patients were stratified into ICM (n = 124) and NICM (n = 104) cohorts. The primary outcome was a composite of death/stroke/new-onset dialysis while actively receiving Impella 5.5 support. Random forests identified preoperative factors predictive of the primary outcome separately for each cohort, with ranking by variable importance.

Results

The primary outcome occurred in 42 (34%) patients with ICM and 35 (34%) patients with NICM. Twenty-one (17%) patients with ICM and 21 (20%) patients with NICM died on Impella 5.5; stroke occurred in 12 (9.7%) patients with ICM and 3 (2.9%) patients with NICM, and new-onset dialysis was initiated in 23 (19%) patients with ICM and 24 (23%) patients with NICM while actively receiving Impella 5.5 support. Risk factors reflecting systemic and myocardial cellular injury, end-organ and cardiopulmonary failure, right ventricular dysfunction, and smaller left ventricular dimensions were most predictive of adverse outcomes in both cohorts. Indications for Impella 5.5 and device strategy (bridge to recovery, advanced therapies, or decision) were not top risk factors in either cohort.

Conclusions

Risk factors related to preoperative stability, right ventricular dysfunction, and left ventricular size were more predictive of adverse outcomes while actively receiving Impella 5.5 support than indication or device strategy. These factors could help identify high-risk patients who may benefit from additional tailored management to reduce their risk for these impactful adverse outcomes while on Impella 5.5 support.

Construction of a metabolism-malnutrition-inflammation prognostic risk score in patients with heart failure with preserved ejection fraction: a machine learning based Lasso-Cox model

BACKGROUND

Metabolic disorder, malnutrition and inflammation are involved and interplayed in the mechanisms of heart failure with preserved ejection fraction (HFpEF). We aimed to construct a Metabolism-malnutrition-inflammation score (MIS) to predict the risk of death in patients with HFpEF.

METHODS

We included patients diagnosed with HFpEF and without infective or systemic disease. 20 biomarkers were filtered by the Least absolute shrinkage and selection operator (Lasso)-Cox regression. 1000 times bootstrapping datasets were generated to select biomarkers that appeared above 95% frequency in repetitions to construct the MIS.

RESULTS

Among 1083 patients diagnosed with HFpEF, 342 patients (31.6%) died during a median follow-up period of 2.5 years. The MIS was finally constructed based on 6 biomarkers, they were albumin (ALB), red blood cell distribution width-standard deviation (RDW-SD), high-sensitivity C-reactive protein (hs-CRP), lymphocytes, triiodothyronine (T3) and uric acid (UA). Incorporating MIS into the basic predictive model significantly increased both discrimination (∆C-index = 0.034, 95% CI 0.013-0.050) and reclassification (IDI, 6.6%, 95% CI 4.0%-9.5%; NRI, 22.2% 95% CI 14.4%-30.2%) in predicting all-cause mortality. In the time-dependent receiver operating characteristic (ROC) analysis, the mean area under the curve (AUC) for the MIS was 0.778, 0.782 and 0.772 at 1, 3, and 5 years after discharge in the cross-validation sets. The MIS was independently associated with all-cause mortality (hazard ratio: 1.98, 95% CI [1.70-2.31], P < 0.001).

CONCLUSIONS

A risk score derived from 6 commonly used inflammatory, nutritional, thyroid and uric acid metabolic biomarkers can effectively identify high-risk patients with HFpEF, providing potential individualized management strategies for patients with HFpEF.

Pulmonary Hypertension in Hemodialysis Patients and Its Determinants: A Hospital Based Cross-Sectional Study

Purpose

Pulmonary hypertension (PH) is a serious complication in hemodialysis patients, which is associated with a significantly increased risk of morbidity and mortality. The present study aims to investigate PH frequency and associated factors in patients undergoing maintenance hemodialysis.

Patients and Methods

This cross-sectional study was conducted in the hemodialysis department of the Shandong Provincial Third Hospital, China, from January 2016 to December 2022. A total of 167 consecutive patients who underwent regular hemodialysis treatment for at least three months were included in the study. Patients with a systolic pulmonary artery pressure (sPAP) value >35 mmHg at rest were considered to have PH. The relationship between PH and various demographic, laboratory, and echocardiographic parameters was evaluated.

Results

A total of 93 patients (55.7%) were diagnosed with PH. Multivariate logistic regression analysis indicated that low serum levels of albumin (OR 0.89, 95% CI 0.82-0.98, p = 0.017), low serum levels of triglycerides (OR 0.32, 95% CI 0.15-0.69, p = 0.003), and high right atrial diameter (OR 1.19, 95% CI 1.04-1.37, p = 0.011) were significantly associated with an increased risk of PH.

Conclusion

PH is a common finding in hemodialysis patients and is independently associated with serum levels of albumin, serum levels of triglyceride, and right atrial diameter; this suggests that evaluating these non-invasive and relatively easily available parameters may be useful in identifying patients with a high risk of PH. However, further studies are required to confirm these findings.

Pleural Effusion and Invasive Hemodynamic Measurements in Advanced Heart Failure

BACKGROUND

Pleural effusion is present in 50% to 80% of patients with acute heart failure, depending on image modality. We aim to describe the association between the presence and size of pleural effusion and central hemodynamics, including pulmonary capillary wedge pressure (PCWP) in an advanced heart failure population.

METHODS

An observational, cross-sectional study in a cohort of patients with advanced heart failure (left ventricular ejection fraction ≤45%) who underwent right heart catheterization at The Department of Cardiology at Copenhagen University Hospital, Rigshospitalet, Denmark, between January 1, 2002 and October 31, 2020. The presence and size of pleural effusion were determined by a semiquantitative score of chest x-rays or computed tomography scans performed within 2 days of right heart catheterization.

RESULTS

In 346 patients (50±13 years; 78% males) with median left ventricular ejection fraction of 20% (15-25), we identified 162 (47%) with pleural effusion. The pleural effusion size was medium in 38 (24%) and large in 30 (19%). Patients with pleural effusion had a 4.3 mm Hg (2.5-6.1) higher PCWP and 2.4 mm Hg (1.2-3.6) higher central venous pressure (P<0.001 for both). Patients with a medium/large pleural effusion had statistically significantly higher filling pressures than patients with a small effusion. Higher PCWP (odds ratio [OR], 1.06 [1.03-1.10]) and central venous pressure (OR, 1.09 [1.05-1.15]) were associated with pleural effusion in multivariable logistic regression adjusted for age, sex, and heart failure medications (P<0.001 for both). In a subgroup of 204 (63%) patients with serum albumin data, PCWP (OR, 1.06 [1.01-1.11]; P=0.032), central venous pressure (OR, 1.14 [1.06-1.23]; P<0.001) and serum albumin level (OR, 0.89 [0.83-0.95]; P<0.001) were independently associated with the presence of a medium/large-sized pleural effusion.

CONCLUSIONS

In patients with left ventricular ejection fraction ≤45% undergoing right heart catheterization as part of advanced heart failure work-up, pleural effusion was associated with higher PCWP and central venous pressure and lower serum albumin.

Malnutrition stratified by marasmus and kwashiorkor in adult patients with heart failure

Malnutrition is classified into marasmus and kwashiorkor in children. However, the clinical significance of these aspects is unclear in adult patients with heart failure (HF). We divided 2308 adult patients with HF into four groups according to marasmus type (body mass index < 18.5 kg/m2) and kwashiorkor type (serum albumin < 3.4 g/dL) malnutrition: Group C (no malnutrition, n = 1511, 65.5%), Group M (marasmus type malnutrition, n = 133, 5.8%), Group K (kwashiorkor type malnutrition, n = 554, 24.0%) and Group MK (marasmic-kwashiorkor type malnutrition, n = 110, 4.8%). Group M showed the lowest blood pressure. Groups K and MK showed higher levels of B-type natriuretic peptide. Right atrial pressure was lowest in Groups M and MK. Kaplan-Meir analysis demonstrated that Group MK had the lowest event-free rate of all-cause death and cardiac death. In the multivariable Cox proportional hazard analysis, Groups M, K, and MK were associated with all-cause death (hazard ratio 1.790, 1.657 and 2.313, respectively) and cardiac death (hazard ratio 2.053, 1.855 and 3.001, respectively) compared to Group C as a reference. Marasmus type and kwashiorkor type malnutrition are associated with distinct profiles and high mortality, and marasmic-kwashiorkor type malnutrition has the poorest prognosis.

Prognostic role of serum albumin levels in patients with chronic heart failure

BACKGROUND

Hypoalbuminemia is common in heart failure (HF) patients; however, there are no data regarding the possible long-term prognostic role of serum albumin (SA) in the younger population with chronic HF without malnutrition. The aim of this study was to examine the long-term prognostic role of SA levels in predicting major adverse cardiac events (MACE) in middle-aged outpatients with chronic HF.

METHODS

In the present retrospective analysis, 378 subjects with HF were enrolled. MACE (non-fatal ischemic stroke, non-fatal myocardial infarction, cardiac revascularization or coronary bypass surgery, and cardiovascular death), total mortality, and HF hospitalizations (hHF) occurrence were evaluated during a median follow-up of 6.1 years.

RESULTS

In all population, 152 patients had a SA value < 3.5 g/dL and 226 had a SA value ≥ 3.5 g/dL. In patients with SA ≥ 3.5 g/dL, the observed MACE were 2.1 events/100 patient-year; while in the group with a worse SA levels, there were 7.0 events/100 patient-year (p < 0.001). The multivariate analysis model confirmed that low levels of SA increase the risk of MACE by a factor of 3.1. In addition, the presence of ischemic heart disease, serum uric acid levels > 6.0 mg/dL, chronic kidney disease, and a 10-year age rise, increased the risk of MACE in study participants. Finally, patients with SA < 3.5 g/dl had a higher incidence of hHF (p < 0.001) and total mortality (p < 0.001) than patients with SA ≥ 3.5 g/dl.

CONCLUSIONS

Patients with chronic HF that exhibits low SA levels show a higher risk of MACE, hHF and total mortality.

The effect of prognostic nutritional index on diabetic patients with myocardial infarction

BACKGROUND

The prognostic nutritional index (PNI), a simple and comprehensive predictor of nutritional and immunological health, is connected to cancer and cardiovascular disease. The effects of PNI on myocardial infarction (MI) in individuals with diabetes remain unclear. Thus, we aim to investigate the correlation of PNI with predictive outcomes in this specific population group to inform therapeutic decision-making.

METHODS

This prospective observational study included 417 diabetic patients with MI who underwent coronary angiography intervention at Fujian Medical University Union Hospital from May 2017 to May 2020. We collected follow-up and prognostic data from these patients at 6, 12, 18, and 24 months post-procedure via outpatient visits or phone interviews. The main focus of the study was on major adverse cardiovascular events (MACE) in the two years after surgery. Based on the median PNI, patients were categorized into two groups: high PNI (H-PNI) and low PNI (L-PNI). Data were analyzed using IBM SPSS 25.0. Kalpan-Meier survival curves and Cox proportional hazards regression analysis were utilized to examine the associations between preoperative PNI and the prognosis of diabetic patients with MI.

RESULTS

In the study, 417 participants were observed for two years. Of these patients, 159 (38.1%) had MACE. According to the Kaplan-Meier curves, patients in the L-PNI group had more MACE than those in the H-PNI group (log-rank p < 0.001) and had a heightened susceptibility to all categories of MACE. After adjusting for confounding variables, the corrected hazard ratio for developing unstable angina in the L-PNI group was 2.55 (95% CI 1.57-4.14, p < 0.001).

CONCLUSION

Low PNI levels are associated with MACE after coronary angiography intervention in diabetic patients with myocardial infarction. This highlights the prognostic value of PNI and broadens its potential use in larger populations.

TRIAL REGISTRATION

Not applicable.

Investigating the mechanism of PAD in the treatment of acne based on network pharmacology and molecular docking: A review

Acne is a common and chronic skin condition characterized by high incidence, recurrent symptoms and difficult cure. Summarizing the clinical treatment experience, it was found that the powder for ascending and descending was effective in the treatment of acne. Our aim was to use network pharmacology and molecular docking to reveal the hub genes, biological functions, and signaling pathways of powder for ascending and descending against acne. First, the chemical components and target genes of PAD were sifted using the TCMSP and HERB database. The targets of acne were obtained simultaneously from the CTD, OMIM and GeneCards database. The obtained drug targets and disease targets were imported into the R language software to draw Venn diagrams. Then, the potential targets were imported into the String website to construct a protein interaction network diagram. And Cytoscape software was used for topological analysis to screen the core targets, and the core targets were analyzed by GO functional enrichment and KEGG pathway enrichment. Finally, molecular docking was used to verify the predictions of key genes' reliability. The core targets of the treatment of acne were TNF, GADPH, IL-6 and so on. The results of enrichment analysis showed that the treatment of acne with PAD may be related to TNF signaling pathway and AGE-RAGE signaling pathway. The molecular docking verification showed that the components were well bound to the core targets of acne, and the docking ability of stigmasterol and TNF (-12.73 kcal/mol) was particularly outstanding.

Uric acid to albumin ratio as a novel predictor for coronary slow flow phenomenon in patients with chronic coronary syndrome and non-obstructive coronary arteries

BACKGROUND

The plasma uric acid to albumin ratio (UAR) is considered as a novel indicator for Inflammation. However, the association between UAR and coronary slow flow phenomenon (CSFP) remains unclear.

METHODS

A total of 1328 individuals with chronic coronary syndrome (CCS) receiving coronary angiography (CAG) and found no obvious obstructive stenosis (< 40%) were included in this study. 79 individuals developed CSFP and were divided into CSFP group. The 1:2 age-matched patients with normal coronary blood flow were allocated to the control group (n = 158). The clinical characteristics, laboratory parameters including uric acid, albumin ratio, UAR and the angiographic characteristics were compared between the two groups.

RESULTS

Patients with CSFP had a higher level of uric acid (392.3 ± 85.3 vs. 273.8 ± 71.5, P < 0.001), UAR (10.7 ± 2.2 vs. 7.2 ± 1.9, P < 0.001), but a lower level of plasma albumin (36.9 ± 4.2 vs. 38.5 ± 3.6, P = 0.003). Moreover, UAR increased as the numbers of vessels involved in CSFP increased. The logistic regression analysis demonstrated that UAR was independent predictors for CSFP. The Receiver operating characteristic (ROC) curve analysis showed that when UAR was more than 7.9, the AUC was 0.883 (95% CI: 0.840-0.927, p < 0.001), with the sensitivity and specificity were 78.2% and 88.2% respectively.

CONCLUSION

Combined uric acid with plasma albumin, UAR could serve as an independent predictor for CSFP.

Assessing the predictive value of the controlling nutritional status score on all-cause mortality during hospitalization in patients with acute decompensated heart failure: a retrospective cohort study from Jiangxi, China

Objective

Nutritional status is closely associated with the prognosis of heart failure. This study aims to assess the relationship between the Controlling Nutritional Status (CONUT) score and in-hospital mortality among patients with acute decompensated heart failure (ADHF) in Jiangxi, China.

Methods

A retrospective cohort study was conducted. Multivariable Cox regression models and restricted cubic spline regression were employed to evaluate the relationship between the CONUT score and in-hospital mortality in ADHF patients from Jiangxi, China. The predictive value of the CONUT score for in-hospital mortality in ADHF patients was analyzed using receiver operating characteristic curves. Subgroup analyses were performed to identify risk dependencies of the CONUT score in specific populations.

Results

The study included 1,230 ADHF patients, among whom 44 (3.58%) mortality events were recorded. After adjusting for confounding factors, a positive correlation was found between the CONUT score and the risk of in-hospital mortality in ADHF patients. Restricted cubic spline regression analysis indicated a non-linear relationship between the CONUT score and the risk of in-hospital mortality in ADHF patients, estimating a rapid increase in mortality risk when the CONUT score exceeded 5. Receiver operating characteristic analysis demonstrated a good predictive value of the CONUT score for all-cause mortality events in ADHF patients [area under the curve = 0.7625, optimal threshold = 5.5]. Additionally, a relatively higher risk associated with the CONUT score was observed in male patients and those with concomitant cerebral infarction.

Conclusion

This study reveals a positive correlation between the CONUT score and the risk of in-hospital mortality in ADHF patients. Based on the findings of this study, we recommend maintaining a CONUT score below 5 for patients with ADHF in Jiangxi, China, as it may significantly contribute to reducing the risk of in-hospital all-cause mortality.

Fatal coinfection of blastocystosis and intestinal trichomoniasis in a rhesus macaque (Macaca mulatta)

A 3-year-old male rhesus macaque was presented at Referral Veterinary Polyclinic-Teaching Veterinary Clinical Complex, with a chief complaint of chronic diarrhoea and swelling of dependent body parts. The patient's history indicates that the monkey had been experiencing diarrhoea for the past month, with 2-3 episodes of vomiting in the last 2 days. Additionally, oedema has developed within the last 2 weeks. The clinical examination findings revealed dullness and depression, the mucus membrane appeared pale, with a temperature-102.1 °F, a respiration rate-28/min, and a heart rate-92/min. The capillary refill time was 4 s. During the physical examination, the animal exhibited oedema on the dependent part of the body and faecal staining around the perineum along with loose yellow stool. Direct saline and iodine mount faecal smear examination revealed the presence of many motile pear-shaped flagellated protozoa and round vacuolated Blastocystis organisms. Giemsa-stained faecal smear cytology confirmed the presence of Pentatrichomonas sp. and Blastocystis sp. along with many microbes. The faecal culture was negative for all pathogenic microbes. The case was diagnosed as co-infection Blastocystosis and intestinal trichomoniasis. The treatment was initiated with a combination of sulfamethoxazole + trimethoprim @ 35 mg/kg body weight and metronidazole @25 mg/kg administered orally once daily for 7 days. Supportive therapy includes hematinic injection (iron sorbitol, folic acid and vitamin B12) @ 1 ml total dose, administered intramuscularly on alternate days for four occasions as well as intravenous infusion of crystalline amino acid @ 5 ml total dose on alternate days for four occasions. To manage vomition, injection ondansetron was administered@0.5 mg/kg intramuscularly, twice daily for 3 days and H2 blockers, including injection ranitidine@2 mg/kg intramuscularly twice daily for 3 days. Electrolyte and probiotic supplementation were administered orally. After 7 days of therapy, the oedema had significantly improved and episodes of vomition were stopped but there was no significant improvement in the episode of diarrhoea and consistency of faeces. Unfortunately, on the 10th day of therapy, the animal suddenly collapsed. Understanding the virulence pattern of opportunistic protozoa in primates is crucial, and identifying suitable therapeutic candidates to prevent fatal outcomes is the need of the hour, especially considering protozoal infections as an important differential diagnosis in gastrointestinal tract-related ailments. Our study successfully demonstrated the co-occurrence of blastocystosis and intestinal trichomoniasis, both uncommon infections with potential zoonotic implications.

Association of serum albumin with heart failure mortality with NYHA class IV in Chinese patients: Insights from PhysioNet database (version 1.3)

BACKGROUND

Studies have proved that low albumin level is associated with increased mortality in most diseases, such as chronic kidney disease and hepatic cirrhosis. However, the relationship between albumin and all-cause death in heart failure patients in China is still unclear.

OBJECTIVES

We aimed to investigate the association between albumin level and 28-day mortality in Chinese hospitalized patients with NYHA IV heart failure.

METHODS

A total of 2008 Chinese patients were included. The correlation between serum albumin level and mortality was tested using a cox proportional hazards regression model. The smooth curve fitting was used to identify non-linear relationships between serum albumin and mortality. The Forest plot analysis was used to assess the association between albumin and 28-day mortality in different groups.

RESULTS

Compared with patients with NYHA II-III, patients with NYHA IV had lower albumin level and higher mortality within 28 days. The albumin on admission was independently and inversely associated with the endpoint risk, which remained significant (hazard ratio: 0.80; 95 % confidence interval: 0.66 to 0.96; p = 0.0196) after multivariable adjustment. The smooth curve fitting showed with the increase of albumin, the mortality within 28 days would decrease. A subgroup analysis found that the inverse association between the albumin level and risk of the mortality was consistent across the subgroup stratified by possible influence factors.

CONCLUSION

Serum albumin level is negatively associated with 28-day mortality in hospitalized heart failure patients within NYHA IV in China, which can be used as an independent predictor.

Predictors and Clinical Significance of Myocardial Injury in Elderly Patients Under the COVID-19 Pandemic

Background

The elderly patients are at increased high risk of myocardial injury and mortality after the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. This study aims to investigate the prevalence, predictors and prognostic implications of myocardial injury in the elderly patients with SARS-CoV-2 infection.

Methods

Patients aged over 65 years were consecutively recruited between April to May, 2022. Myocardial injury was assessed using the high-sensitivity cardiac troponin T (hs-cTnT) assay. The primary endpoint was in-hospital mortality.

Results

A total of 347 patients were recruited with a median age of 81 years. 45.8% were male and 18 (5.2%) deceased before discharge. Myocardial injury (hs-cTnT over 99% upper reference limit [URL]) was detected in 202 (58.2%) of patients. Predictors of myocardial injury included age (per 5-year increase), hypertension, vaccination, creatine, and neutrophil-to-lymphocyte ratio. hs-cTnT over 3 × URL was independently correlated with in-hospital mortality (adjusted odds ratio [adOR], 13.21; 95% confidence interval [CI], 2.11-87.1; p = 0.005) in comparison to hs-cTnT > URL (adOR, 0.66; 95% CI, 0.09-5.92; p = 0.680).

Conclusion

Myocardial injury was a common phenomenon and prognostic predictor in elder patients after SARS-CoV-2 infection. Higher threshold of myocardial injury may be considered to improve risk stratification.

Serum albumin and cardiovascular disease: a Mendelian randomization study

BACKGROUND

An increasing body of evidence suggests that serum albumin levels play a role in cardiovascular diseases. However, the specific causal relationship between serum albumin levels and cardiovascular disease remains partially unknown.

METHODS

Mendelian randomization (MR) was employed in this study to examine potential causal relationships between instrumental variables and cardiovascular diseases. Specifically, we utilized genetic variants of serum albumin levels within the reference range as our instrumental variables. To acquire data on genetic associations with cardiovascular diseases, we sourced information from renowned genome-wide association studies such as UK BioBank, EMBL-EBI, and FinnGen. Notably, our study leveraged summary statistics from large cohorts that have been previously described.

RESULTS

We explored the association between serum albumin levels and various conditions, including heart failure (HF), venous thromboembolism (VTE), stroke, atrial fibrillation (AF), coronary artery disease (CAD), type 2 diabetes (T2DM), and pulmonary heart disease (PHD). Genetically predicted serum albumin levels were associated with PHD (odds ratio = 0.737, 95% CI = 0.622 - 0.874, P < 0.001), AF (odds ratio = 0.922, 95% CI = 0.870 - 0.977, P = 0.006), VTE (odds ratio = 0.993, 95% CI = 0.991 - 0.995, P < 0.001), and Stroke (odds ratio = 0.997, 95% CI = 0.995 - 0.999, P = 0.002). However, genetically predicted serum albumin level traits were not associated with HF, CAD and T2DM.

CONCLUSION

Our study demonstrates a significant association between serum albumin levels and cardiovascular disease, underscoring the crucial role of low serum albumin as a predictive factor in patients with cardiovascular disease.

Low Prognostic Nutritional Index Predicts Adverse Outcomes in Patients With Heart Failure: A Systematic Review and Meta-analysis

The association of low prognostic nutritional index (PNI) with adverse outcomes remains conflicting in heart failure patients. To address these knowledge gaps, we performed this meta-analysis to investigate the predictive value of PNI in patients with heart failure (HF). PubMed and Embase databases were comprehensively searched until January 19, 2023, to identify studies that evaluated the predictive role of PNI in HF patients. Outcomes of interest included all-cause mortality and/or combined endpoint of mortality and re-hospitalization. Twelve studies involving 9365 patients with HF were included and analyzed. Comparison of the lowest with the highest PNI, the pooled multivariate adjusted risk ratio (RR) was 1.79 (95% confidence interval [CI] 1.40-2.30) and 2.67 (95% CI 1.92-3.71) for long-term all-cause mortality and combined endpoint of mortality and re-hospitalization, respectively. Furthermore, per unit reduction in PNI was associated with 8% higher risk of all-cause mortality. However, there was no clear association of low PNI with in-hospital mortality. Low PNI may be an independent predictor of long-term all-cause mortality and re-hospitalization in patients with HF. Estimation of nutritional state using the PNI may provide an important clue for risk stratification in these patients.

Combined Serum Albumin and Left Ventricular Ejection Fraction Predict All-Cause Death in Patients with Stable Coronary Artery Disease

Objective

To explore the feasibility of serum albumin (Alb) and left ventricular ejection fraction (LVEF) in predicting all-cause death (ACD) in patients with stable coronary artery disease (SCAD).

Methods

Patients with SCAD were divided into 4 groups according to their Alb and LVEF levels: Group A: Alb ≤4 g/dL and LVEF > 50%; Group B: Alb ≤4 g/dL and LVEF ≤50%; Group C: Alb >4 g/dL and LVEF ≤50%; Group D: Alb >4 g/dL and LVEF >50%. The K-M curve and log-rank test were used to compare ACD among the four groups over three years. Receiver operating characteristic (ROC) curves were used to compare the efficacy of predicting ACD among the combination of Alb and LVEF and either Alb or LVEF alone. Cox regression analysis identified the influencing factors of ACD in patients with SCAD and detected the correlation between Alb and LVEF.

Results

ACD occurred in 18 (8.9%) of 203 patients with SCAD, with an average follow-up of 26.53 ± 14.34 months. In the Kaplan‒Meier analysis, the risk of ACD in the four groups ranged from high to low: Group B (17.6%) > Group A (26.7%) > Group D (0.9%) > Group C (0%, P < 0.001). The ROC curve showed that the combination of Alb and LVEF (AUC = 0.888) had better predictive value for ACD than either Alb (AUC = 0.879) or LVEF alone (AUC = 0.651), P < 0.001. Multivariate Cox regression analysis showed that Alb ≤4 g/dL predicted ACD events after adjusting for baseline (HR: 12.16, 95% CI: 1.57 to 94.41; P=0.017) and treatment (HR: 19.36, 95% CI: 2.53-147.78, P=0.004). Alb was positively correlated with LVEF (r = 0.22, P=0.002).

Conclusions

Alb combined with LVEF is more effective than a single index in predicting ACD in SCAD and could be used as a new model to judge the prognosis of SCAD.

Blood urea nitrogen to serum albumin ratio: a novel mortality indicator in intensive care unit patients with coronary heart disease

The blood urea nitrogen to albumin ratio (BAR) has been demonstrated as a prognostic factor in sepsis and respiratory diseases, yet its role in severe coronary heart disease (CHD) remains unexplored. This retrospective study, utilizing data from the Medical Information Mart for Intensive Care-IV database, included 4254 CHD patients, predominantly male (63.54%), with a median age of 74 years (IQR 64-83). Primary outcomes included in-hospital, 28-day and 1-year all-cause mortality after ICU admission. The Kaplan-Meier curves, Cox regression analysis, multivariable restricted cubic spline regression were employed to assess association between BAR index and mortality. In-hospital, within 28-day and 1-year mortality rates were 16.93%, 20.76% and 38.11%, respectively. Multivariable Cox proportional hazards analysis revealed associations between the increased BAR index and higher in-hospital mortality (HR 1.11, 95% CI 1.02-1.21), 28-day mortality (HR 1.17, 95% CI 1.08-1.27) and 1-year mortality (HR 1.23, 95% CI 1.16-1.31). Non-linear relationships were observed for 28-day and 1-year mortality with increasing BAR index (both P for non-linearity < 0.05). Elevated BAR index was a predictor for mortality in ICU patients with CHD, offering potential value for early high-risk patient identification and proactive management by clinicians.

Effect of hypoproteinemia on mortality of elderly male patients with chronic heart failure

To explore the effect of hypoproteinemia on cardiac function and prognosis in elderly male patients with chronic heart failure. Among the patients with chronic heart failure hospitalized in the General Hospital of Southern Theater Command from December 2014 to December 2015, 100 elderly male patients with chronic heart failure were selected. The patients were divided into 2 groups based on their serum albumin (ALB) levels: 53 cases in the normal group (ALB ≥ 35 g/L) and 47 cases in the hypoproteinemia group (ALB < 35 g/L). Using the method of prospective study, under the condition of routine treatment of heart failure, follow-up observation for 5 years, we collected relevant data and analyzed the level of serum ALB, cardiac function and prognosis of patients in these 2 groups. The mortality of patients in the hyporoteinemia group were significantly higher than those in the normal group. Left ventricular end-diastolic dimension (LVDD) and brain natriuretic peptide (BNP) in the normal group after 5 years were markedly lower compared with that in the hypoproteinemia group. The mortality of patients with chronic heart failure with hypoproteinemia were higher, and the present study indicated that the ALB level may be associated with the mortality of patients with chronic heart failure.

Myocardial function using two dimension speckle-tracking echocardiography in children with celiac disease

The prevalence of cardiac complications linked to celiac disease (CD) is on expanding. This study aimed to evaluate the cardiac function in children with CD using two dimensional speckle tracking echocardiography (2D-STE) to detect early myocardial dysfunction, if any. This cross-sectional study included 40 children with CD as the patient group and 40 healthy age- and sex-matched children served as the control group. High sensitive troponin T (Hs-troponin T), anti-tissue transglutaminase immunoglobulin A (tTG-IgA), hemoglobin, ferritin, albumin, and vitamin D levels were measured in all participants. Conventional, tissue Doppler imaging (TDI), and 2D-STE were performed for all included children. Conventional echocardiographic parameters showed no significant difference between the two groups. Left ventricular global longitudinal strain (LV GLS) obtained by 2D-STE was substantially lower in children with CD than the control group; however, myocardial performance index (MPI) obtained by TDI was significantly higher in children with CD. Hs-troponin T levels were comparable in both groups. LV GLS was positively correlated with hemoglobin, ferritin, and albumin level, but it was inversely correlated with the duration of the disease and anti tTG-IgA.    Conclusion: 2D-STE can detect subclinical early cardiac dysfunction in children with CD and this cardiac injury correlated to the duration and severity of the disease and some nutritional deficiency in these children. What is Known: • The prevalence of cardiac complications linked to celiac disease (CD) is on expanding. • Only one study evaluated cardiac function in children with CD using two dimensional speckle tracking echocardiography (2D-STE). What is New: • Our study found that 2D-STE can detect early subclinical cardiac dysfunction in children with CD. Cardiac injury in theses children correlated to the duration and severity of the disease, hemglobin, ferritin, and albumin levels.

Association of D-dimer to albumin ratio with adverse cardiovascular outcomes in ischaemic heart failure patients with diabetes mellitus: a retrospective cohort study

OBJECTIVE

To determine the association of D-dimer to albumin ratio (DAR) with major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) in ischaemic heart failure patients with diabetes mellitus.

DESIGN

A retrospective observational cohort study.

SETTING

Single centre in Beijing, China, conducted at one of the largest cardiology centres in China.

PARTICIPANTS

From June 2017 to June 2019, 3707 patients with heart failure and concomitant multiple vessel disease undergoing elective PCI were screened. A total 1021 of patients were enrolled after exclusion and the follow-up period was up to 36 months.

PRIMARY AND SECONDARY OUTCOME MEASURES

The MACE was the primary measured outcome. The secondary outcomes were all-cause mortality, non-fatal myocardial infarction and any revascularisation.

METHODS

These participants were grouped according to DAR tertiles. The cumulative incidence functions, Cox regression, restricted cubic spline and receiver operating characteristic curves were used to determine the association between DAR and outcomes. The subgroup analysis was also performed.

RESULTS

After follow-up, MACE occurred in 404 (39.6%) participants. The cumulative hazards curve manifested significant differences in MACE, all-cause mortality and any revascularisation (log-rank test: all p<0.001). In adjusted models, DAR was an independent risk factor of MACE (tertile 2: HR 1.82, 95% CI 1.37 to 2.42; tertile 3: HR 1.74, 95% CI 1.28 to 2.36) and all-cause mortality (tertile 2: HR 2.04, 95% CI 1.35 to 3.11; tertile 3: HR 1.89, 95% CI 1.20 to 2.98). The optimal cut-off of DAR was 1.2. In the stratified analysis, sex, age, hypertension, hypercholesterolaemia, total revascularisation and any interfered vessel did not affect the independent predictive ability.

CONCLUSION

Higher DAR was independently associated with MACE and all-cause mortality after PCI in ischaemic heart failure patients with diabetes mellitus.

Does the geriatric nutritional risk index predict complication rates and implant survivorship in revision total joint arthroplasty?

INTRODUCTION

Malnutrition is associated with poorer outcomes after revision total joint arthroplasty (rTJA), though no universal metric for assessing malnutrition in rTJA patients has been reported. This study sought to determine if malnutrition as defined by the Geriatric Nutritional Risk Index (GNRI) can independently predict short-term complication rates and re-revision risk in patients undergoing rTJA.

METHODS

All patients ≥ 65 years old undergoing rTJA from 2011 to 2021 at a single orthopaedic specialty hospital were identified. Preoperative albumin, height, and weight were used to calculate GNRI. Based on the calculated GNRI value, patients were stratified into three groups: normal nutrition (GNRI > 98), moderate malnutrition (GNRI 92-98), and severe malnutrition (GNRI < 92). Chi-squared and independent samples t-tests were used to compare groups.

RESULTS

A total of 531 rTJA patients were included. Patients with normal nutrition were younger (p < 0.001), had higher BMI (p < 0.001). After adjusting for baseline characteristics, patients with severe and moderate malnutrition had longer length of stay (p < 0.001), were less likely to be discharged home (p = 0.049), and had higher 90-day major complication (p = 0.02) and readmission (p = 0.005) rates than those with normal nutrition. 90-day revision rates were similar. In Kaplan-Meier analyses, patients with severe and moderate malnutrition had worse survivorship free of all-cause re-revision at 1-year (p = 0.001) and 2-year (p = 0.002) follow-up compared to those with normal nutrition.

CONCLUSION

Moderate and severe malnutrition, as defined by GNRI, independently predicted higher complication and revision rates in rTJA patients. This suggests that the GNRI may serve as an effective screening tool for nutritional status in patients undergoing rTJA.

The neutrophil percentage-to-albumin ratio is associated with all-cause mortality in patients with chronic heart failure

BACKGROUND

In this study, we evaluated the predictive utility of neutrophil percentage-to-albumin ratio (NPAR) for all-cause mortality in patients with chronic heart failure (CHF).

METHODS

Patients diagnosed as CHF enrolled in this retrospective cohort study were from Beijing Chaoyang Hospital, capital medical university. Admission NPAR was calculated as neutrophil percentage divided by serum albumin. The endpoints of this study were defined as 90-day, 1-year and 2-year all-cause mortality. Multivariable Cox proportional hazard regression model was performed to confirm the association between NPAR and all-cause mortality. Receiver operating characteristics (ROC) curves were used to evaluate the ability for NPAR to predict all-cause mortality.

RESULTS

The 90-day (P = 0.009), 1-year (P < 0.001) and 2-year (P < 0.001) all-cause mortality in 622 patients with CHF were increased as admission NPAR increased. Multivariable Cox regression analysis found the higher NPAR value was still independently associated with increased risk of 90-day (Group III versus Group I: HR, 95% CI: 2.21, 1.01-4.86, P trend = 0.038), 1-year (Group III versus Group I: HR, 95% CI:2.13, 1.30-3.49, P trend = 0.003), and 2-year all-cause mortality (Group III versus Group I: HR, 95% CI:2.06, 1.37-3.09, P trend = 0.001), after adjustments for several confounders. ROC curves revealed that NPAR had a better ability to predict all-cause mortality in patients with CHF, than either albumin or the neutrophil percentage alone.

CONCLUSIONS

NPAR was independently correlated with 90-day, 1-year, and 2-year all-cause mortality in patients with CHF.

Prognostic value of albumin to fibrinogen ratio for mortality in patients with hypertrophic cardiomyopathy

BACKGROUND

Albumin to fibrinogen ratio (AFR), a new inflammatory marker, has emerged as a useful indicator to predict adverse outcomes for several diseases. However, whether AFR could be a new useful indicator to predict mortality in HCM patients remains to be evaluated. The study explored the predictive value of AFR for HCM-related death in adult HCM patients.

METHODS

A total of 404 HCM patients were eventually enrolled in the study according to the inclusion criteria. Patients were divided into two groups based on the median of baseline AFR. The association between AFR and HCM-related death was analyzed.

RESULTS

During a median follow-up of 4.75 years, HCM-related death was observed in 45 patients (11.1%). The incidence of HCM-related death was significantly higher in the low AFR group (log-rank p < 0.001). With the high AFR group as reference, the unadjusted hazard ratio (HR) for HCM-related death was 2.97 (95% confidence interval [CI]: 1.53-5.75, p = 0.001) in the low AFR group, and after adjusting for potentially confounding variables, the adjusted HR for low AFR group was 3.15 (95% CI: 1.56-6.37, p = 0.001). No significant interactions between AFR and other variables were observed in subgroup analysis. Sensitivity analyses in patients with normal albumin and fibrinogen showed similar results.

CONCLUSION

AFR is an independent prognostic factor for HCM-related death, adult HCM patients with a lower AFR have a higher risk of HCM-related death.

Impact of hypoalbuminemia on in-hospital mortality in patients with takotsubo syndrome: A multicenter registry of the Tokyo Cardiovascular Care Unit Network

BACKGROUND

Hypoalbuminemia is common in critically ill patients and is associated with poor outcomes. However, the relationship between serum albumin levels and clinical outcomes in patients with takotsubo syndrome remains unclear. We examined the impact of hypoalbuminemia on in-hospital mortality in patients with takotsubo syndrome.

METHODS

Using the multicenter registry of the Tokyo Cardiovascular Care Unit Network between January 2017 and December 2020, we identified 631 eligible patients with takotsubo syndrome (median age, 78 years; male proportion, 22 %) and documented serum albumin levels at admission, which were used to allocate patients to hypoalbuminemia (serum albumin <3.5 g/dL) or normal albumin (serum albumin ≥3.5 g/dL) groups. Patient characteristics and in-hospital mortality were compared between the groups.

RESULTS

Hypoalbuminemia was detected in 200 (32 %) patients at admission. The hypoalbuminemia group was older and had a higher proportion of men and preceding physical triggers than the normal albumin group. In-hospital all-cause mortality was greater in the hypoalbuminemia group than in the normal albumin group (9.5 % vs. 1.9 %, p < 0.001). Both cardiac (3.0 % vs. 0.5 %, p = 0.015) and non-cardiac (6.5 % vs. 1.4 %, p = 0.002) mortality was greater in the hypoalbuminemia group. In multivariable logistic regression analysis, hypoalbuminemia was independently associated with increased in-hospital mortality, even after adjusting for confounders, including age, sex, and triggering events (odds ratio, 3.23; 95 % confidence interval, 1.31-7.95; p = 0.011).

CONCLUSIONS

In patients with takotsubo syndrome, hypoalbuminemia is a common comorbidity and is associated with a substantial risk of in-hospital death. Close monitoring and comprehensive critical care are required in these patients.

Association between fibrinogen-to-albumin ratio and prognosis of patients with heart failure

BACKGROUND

Systemic inflammation is closely associated with the development and progression of heart failure (HF), increasing vulnerability to thromboembolic events. This retrospective cohort study assessed the potential of the fibrinogen-to-albumin ratio (FAR), a new inflammatory biomarker, as a prognostic indicator for HF risk.

METHODS

One thousand one hundred and sixty six women and 826 men with a mean age of 70.70 ± 13.98 years were extracted from the Medical Information Mart for Intensive Care-IV (MIMIC-IV v2.0) database. Additionally, a second cohort was obtained, including 309 patients from the Second Affiliated Hospital of Wenzhou Medical University. The relationship between FAR and the prognosis of HF was evaluated using multivariate analysis, propensity score-matched analysis, and subgroup analysis.

RESULTS

Fibrinogen-to-albumin ratio was an independent risk factor for 90-day all-cause mortality (hazard ratio: 1.19; 95% confidence interval (CI): 1.01-1.40), 1-year all-cause mortality (hazard ratio: 1.23; 95% confidence interval: 1.06-1.41), and length of hospital stay (LOS) (β: 1.52; 95% CI: 0.67-2.37) in the MIMIC-IV dataset, even after adjusting for potential covariates. These findings were verified in the second cohort (β: 1.82; 95% CI: 0.33-3.31) and persisted after propensity score-matching and subgroup analysis. FAR was positively correlated with C-reactive protein, NT-proBNP, and Padua score. The correlation between FAR and NT-proBNP (R = .3026) was higher than with fibrinogen (R = .2576), albumin (R = -.1822), platelet-to-albumin ratio (R = .1170), and platelet-to-lymphocyte ratio (R = .1878) (ps  < .05).

CONCLUSIONS

Fibrinogen-to-albumin ratio is an independent risk prognostic factor for 90-day, 1-year all-cause mortality and LOS among HF patients. Inflammation and prothrombotic state may underlie the relationship between FAR and poor prognosis in HF.

Development and validation of the prediction model for mortality in patients with diabetic kidney disease in intensive care unit: a study based on medical information Mart for intensive care

We aimed to explore factors associated with mortality of diabetic kidney disease (DKD), and to establish a prediction model for predicting the mortality of DKD. This was a cohort study. In total, 1,357 DKD patients were identified from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, with 505 DKD patients being identified from the MIMIC-III as the testing set. The outcome of the study was 1-year mortality. COX proportional hazard models were applied to screen the predictive factors. The prediction model was conducted based on the predictive factors. A receiver operating characteristic (ROC) curve with the area under the curve (AUC) was calculated to evaluate the performance of the prediction model. The median follow-up time was 365.00 (54.50,365.00) days, and 586 patients (43.18%) died within 1 year. The predictive factors for 1-year mortality in DKD included age, weight, sepsis, heart rate, temperature, Charlson Comorbidity Index (CCI), Simplified Acute Physiology Score (SAPS) II, and Sequential Organ Failure Assessment (SOFA), lymphocytes, red cell distribution width (RDW), serum albumin, and metformin. The AUC of the prediction model for predicting 1-year mortality in the training set was 0.771 [95% confidence interval (CI): 0.746-0.795] and the AUC of the prediction model in the testing set was 0.795 (95% CI: 0.756-0.834). This study establishes a prediction model for predicting mortality of DKD, providing a basis for clinical intervention and decision-making in time.

Development of a High-Accuracy, Low-Cost, and Portable Fluorometer with Smartphone Application for the Detection of Urinary Albumin towards the Early Screening of Chronic Kidney and Renal Diseases

This study presents the development of a portable fluorometer with a smartphone application designed to facilitate the early screening of chronic kidney and renal diseases by enabling the sensitive detection of urinary albumin. Utilizing a fluorescence-based aptasensor, the device achieved a linear calibration curve (0.001-1.5 mg/mL) with a linearity of up to 0.98022 and a detection limit of 0.203 µg/mL for human serum albumin (HSA). The analysis of 130 urine samples demonstrated comparable performance between this study's fluorometer, a commercial fluorometer, and the standard automated method. These findings validate the feasibility of the portable fluorometer and aptasensor combination as a reliable instrument for the sensitive and specific measurement of HSA in urine samples. Moreover, the fluorometer's portability offers potential applications in portable point-of-care testing, enhancing its utility in clinical settings for early disease screening.

Incorporating inflammatory biomarkers into a prognostic risk score in patients with non-ischemic heart failure: a machine learning approach

Objectives

Inflammation is involved in the mechanisms of non-ischemic heart failure (NIHF). We aimed to investigate the prognostic value of 21 inflammatory biomarkers and construct a biomarker risk score to improve risk prediction for patients with NIHF.

Methods

Patients diagnosed with NIHF without infection during hospitalization were included. The primary outcome was defined as all-cause mortality and heart transplantations. We used elastic net Cox regression with cross-validation to select inflammatory biomarkers and construct the best biomarker risk score model. Discrimination, calibration, and reclassification were evaluated to assess the predictive value of the biomarker risk score.

Results

Of 1,250 patients included (median age, 53 years, 31.9% women), 436 patients (34.9%) experienced the primary outcome during a median of 2.8 years of follow-up. The final biomarker risk score included high-sensitivity C-reactive protein-to-albumin ratio (CAR) and red blood cell distribution width-standard deviation (RDW-SD), both of which were 100% selected in 1,000 times cross-validation folds. Incorporating the biomarker risk score into the best basic model improved the discrimination (ΔC-index = 0.012, 95% CI 0.003-0.018) and reclassification (IDI, 2.3%, 95% CI 0.7%-4.9%; NRI, 17.3% 95% CI 6.4%-32.3%) in risk identification. In the cross-validation sets, the mean time-dependent AUC ranged from 0.670 to 0.724 for the biomarker risk score and 0.705 to 0.804 for the basic model with a biomarker risk score, from 1 to 8 years. In multivariable Cox regression, the biomarker risk score was independently associated with the outcome in patients with NIHF (HR 1.76, 95% CI 1.49-2.08, p < 0.001, per 1 score increase).

Conclusions

An inflammatory biomarker-derived risk score significantly improved prognosis prediction and risk stratification, providing potential individualized therapeutic targets for NIHF patients.

Novel insights about albumin in cardiovascular diseases: Focus on heart failure

The Human Plasma Proteome has always been the most investigated compartment in proteomics-based biomarker discovery, and is considered the largest and deepest version of the human proteome, reflecting the state of the body in health and disease. Even if efforts have been always dedicated to the refinement of proteomic approaches to investigate more deeply the plasma proteome, it should not be forgotten that also highly abundant plasma proteins, like human serum albumin (HSA), often neglected in these studies, might provide fundamental physiological functions in plasma, and should be better considered. This review summarizes the important roles of HSA in the context of cardiovascular diseases (CVD), and in particular in heart failure. Notwithstanding much attention has been historically directed toward the association of HSA levels and CVD risk, the advances in the field of mass spectrometry research allow also a better characterization of the effects of oxidative modifications that could alter not only the structure but also the function of HSA.

Association of albumin levels with the risk of intracranial atherosclerosis

OBJECTIVE

Intracranial artery stenosis from atherosclerosis is one of the etiologies of ischemic stroke. There is a correlation between serum albumin level and atherosclerosis. We aimed to investigate whether serum albumin level is related to intracranial atherosclerosis and its significance.

METHODS

A retrospective analysis of 150 individuals who underwent cervical cerebral angiography after admission, including clinical data, imaging data, and laboratory data. Since atherosclerosis cannot be used as a good quantitative indicator, we choose the degree of arterial stenosis to reflect atherosclerosis. SPSS 24 software was used for data analysis, and P < .05 was considered statistically significant.

RESULTS

Univariate analysis showed that age, diabetes, and serum albumin level were risk factors for intracranial atherosclerosis (P < .05). Multivariate analysis showed that diabetes and serum albumin levels were independent risk factors for intracranial atherosclerosis (P< 0.05). The average serum albumin level in the non-severe group was 39.80 g/L, and the average serum albumin level in the severe group was 37.60 g/L. The area under the ROC curve of serum albumin was 0.667 (95%CI 0.576-0.758, P = .001), the cutoff value was 0.332176, the sensitivity was 75.9%, and the specificity was 57.3%.

CONCLUSION

Serum albumin level is an independent risk factor for intracranial atherosclerosis, and provides a new direction for clinical prevention and treatment.

A streamlined, machine learning-derived approach to risk-stratification in heart failure patients with secondary tricuspid regurgitation

AIMS

Secondary tricuspid regurgitation (sTR) is the most frequent valvular heart disease and has a significant impact on mortality. A high burden of comorbidities often worsens the already dismal prognosis of sTR, while tricuspid interventions remain underused and initiated too late. The aim was to examine the most powerful predictors of all-cause mortality in moderate and severe sTR using machine learning techniques and to provide a streamlined approach to risk-stratification using readily available clinical, echocardiographic and laboratory parameters.

METHODS AND RESULTS

This large-scale, long-term observational study included 3359 moderate and 1509 severe sTR patients encompassing the entire heart failure spectrum (preserved, mid-range and reduced ejection fraction). A random survival forest was applied to investigate the most important predictors and group patients according to their number of adverse features.The identified predictors and thresholds, that were associated with significantly worse mortality were lower glomerular filtration rate (<60 mL/min/1.73m2), higher NT-proBNP, increased high sensitivity C-reactive protein, serum albumin < 40 g/L and hemoglobin < 13 g/dL. Additionally, grouping patients according to the number of adverse features yielded important prognostic information, as patients with 4 or 5 adverse features had a fourfold risk increase in moderate sTR [4.81(3.56-6.50) HR 95%CI, P < 0.001] and fivefold risk increase in severe sTR [5.33 (3.28-8.66) HR 95%CI, P < 0.001].

CONCLUSION

This study presents a streamlined, machine learning-derived and internally validated approach to risk-stratification in patients with moderate and severe sTR, that adds important prognostic information to aid clinical-decision-making.

Prognostic Significance of Nutrition-Associated Markers in Heart Failure with Preserved Ejection Fraction: A Systematic Review and Meta-Analysis

BACKGROUND

The prognostic significance of nutrition indicators in patients with heart failure with preserved ejection fraction (HFpEF) is unclear.

OBJECTIVES

This systematic review and meta-analysis aimed to assess the prognostic value of serum albumin (SA), the geriatric nutritional risk index (GNRI), and the prognostic nutritional index (PNI) in patients with HFpEF.

METHODS

Databases of PubMed, Embase, The Cochrane Library, and Web of Science were systematically searched for all studies published up to January 2022. The prognostic significance of SA, GNRI, and PNI for HFpEF was explored. Pooled hazard ratio (HR) and 95% confidence interval (CI) were estimated using the STATA 15.0 software. The Quality of Prognosis Studies tool was used to assess the quality of studies.

RESULTS

Nine studies met the inclusion criteria, and 5603 adults with HFpEF were included in the meta-analysis. The analyses showed that a decreased SA or GNRI was significantly related to high all-cause mortality (HR: 1.98; 95% CI: 1.282-3.057; p = 0.002; and HR: 1.812;95% CI: 1.064-3.086; p = 0.029, respectively). Furthermore, a lower SA indicates a bad composite outcome of all-cause mortality and HF rehospitalization (HR: 1.768; 95% CI: 1.483-2.108; p = 0.000), and a lower GNRI was significantly associated with high cardiovascular mortality (HR: 1.922; 95% CI: 1.504-2.457;p = 0.000). However, a lower PNI did not correlate with all-cause mortality (HR: 1.176; 95% CI: 0.858-1.612, p=0.314).

CONCLUSIONS

Our meta-analysis indicates that SA and GNRI may be useful indicators to predict the prognosis of patients with HFpEF.

Co-Administration of Albumin and Furosemide in Acute Heart Failure with Diuretics Resistance

Acute heart failure is a frequent cause of hospital admission in Portugal, and has an increasing tendency given the aging population. Although most admissions for acute heart failure are caused by congestive conditions, not all patients have a congestive phenotype, reflecting the complexity of a process with multiple pathophysiological pathways. The use of diuretics, usually loop diuretics, is the mainstay of treatment for congestion. However, many patients develop resistance, thus constituting a challenge with no consensual solution to date, despite extensive debate over the years. Despite its frequent use in clinical practice, the co-administration of albumin and furosemide remains controversial in the management of patients with acute heart failure, hypoalbuminemia, and diuretic resistance. This review addresses the pathophysiological mechanisms of congestion in patients with acute heart failure and explores the theoretical basis that supports the co-administration of albumin and furosemide in this clinical context. It is intended to clarify the potential benefit of the combined approach in this specific population and identify possible gaps in the literature that could be the subject of future studies.

Association between serum albumin and outcomes in heart failure and secondary mitral regurgitation: the COAPT trial

AIMS

Low serum albumin levels are associated with poor prognosis in numerous chronic disease states but the relationship between albumin and outcomes in patients with heart failure (HF) and secondary mitral regurgitation (SMR) has not been described.

METHODS AND RESULTS

The randomized COAPT trial evaluated the safety and effectiveness of transcatheter edge-to-edge repair (TEER) with the MitraClip^TM plus guideline-directed medical therapy (GDMT) versus GDMT alone in patients with symptomatic HF and moderate-to-severe or severe SMR. Baseline serum albumin levels were measured at enrolment. Among 614 patients enrolled in COAPT, 559 (91.0%) had available baseline serum albumin levels (median 4.0 g/dl, interquartile range 3.7-4.2 g/dl). Patients with albumin <4.0 g/dl compared with ≥4.0 g/dl were older and more likely to have ischaemic cardiomyopathy and a hospitalization within the year prior to enrolment. After multivariable adjustment, patients with albumin <4.0 g/dl had higher 4-year rates of all-cause death (63.7% vs. 47.6%; adjusted hazard ratio 1.34, 95% confidence interval 1.02-1.74; p = 0.032), but there were no significant differences in HF hospitalizations (HFH) or all-cause hospitalizations according to baseline serum albumin level. The relative effectiveness of TEER plus GDMT versus GDMT alone was consistent in patients with low and high albumin levels (p_interaction  = 0.19 and 0.35 for death and HFH, respectively).

CONCLUSION

Low baseline serum albumin levels were independently associated with reduced 4-year survival in patients with HF and severe SMR enrolled in the COAPT trial, but not with HFH. Patients treated with TEER derived similarly robust reductions in both death and HFH regardless of baseline albumin level.

Association of C-reactive protein to albumin ratio with postoperative delirium and mortality in elderly patients undergoing hip fracture surgery: A retrospective cohort study in a single large center

BACKGROUND

Postoperative delirium is a common complication in elderly patients who have undergone hip fracture surgery. Since postoperative delirium is associated with poor outcomes and the treatment is very complicated, identifying the patients at high risk for delirium and providing more attentive care to prevent postoperative delirium is essential. In this study, we aimed to assess the association of an elevated C-reactive protein (CRP)/albumin ratio with the increased incidence of postoperative delirium in elderly people who had undergone hip fracture surgery.

METHODS

A total of 629 patients who underwent hip fracture surgery between January 2014 and December 2018 were retrospectively analyzed. Patients were classified into two groups according to preoperative CRP/albumin cut-off levels (<1.5 and ≥1.5). We performed a propensity score matching analysis to compare the incidence of postoperative delirium and overall mortality between the two groups. Multivariate logistic regression and Cox regression analyses were performed to examine the association of the preoperative CRP/albumin ratio with postoperative delirium and overall mortality.

RESULTS

There were significant differences in the incidence of postoperative delirium (18.0 % vs. 35.8 %, P < 0.001) and overall mortality (26.7 % vs. 46.9 %, P < 0.001) between the groups before matching. We also observed significant differences in the incidence of postoperative delirium (20.7 % vs. 32.7 %, P = 0.019) and overall mortality (34.7 % vs. 46.0 %, P = 0.046) between the groups after matching. A high CRP/albumin ratio (≥1.5) was significantly associated with a higher incidence of postoperative delirium (adjusted odds ratio [OR]: 2.11, 95 % confidence interval [CI]: 1.40-3.18, P < 0.001) and a higher rate of overall mortality (adjusted hazard ratio [HR]: 1.44, 95 % CI: 1.07-1.93, P = 0.015).

CONCLUSION

Preoperative CRP/albumin ratio might be an independent risk factor of postoperative delirium and surgical prognosis in elderly patients undergoing hip fracture surgery.