Prognostic implications of prealbumin level on admission in patients with acute heart failure referred to a cardiac intensive care unit

Abstract

Background: Prealbumin is a marker of nutritional and inflammatory status, and low prealbumin level at discharge is associated with poor outcome in hospitalized patients with heart failure. However, the prognostic value of prealbumin level on admission in patients with acute heart failure (AHF) has not been established, especially in an acute care setting. We aimed to clarify the association between prealbumin level on admission and outcome in patients with AHF referred to a cardiac intensive care unit.

Methods: We analyzed 186 hospitalized patients with AHF who had their prealbumin level examined within 24h of admission.

Results: The mean prealbumin level was 16.6±6.5mg/dL. Prealbumin effectively predicted all-cause death during the median follow-up period of 276 days, using receiver operating characteristic (ROC) curve analysis (the area under the ROC curve; 0.722, optimal cut-off point; ≤14.0mg/dL, sensitivity 71.0%; specificity 69.7%; p<0.001). The all-cause mortality and the composite endpoints of all-cause death or readmission for AHF in patients with low prealbumin level (≤14.0mg/dL) were significantly higher than in patients with high prealbumin level (log-rank p<0.001 and p=0.002). Multivariate analysis adjusted for established markers of AHF severity showed that prealbumin ≤14.0mg/dL was independently associated with higher mortality (hazard ratio 4.79; 95% confidence interval 1.89-12.2; p=0.001) and with the composite endpoints (hazard ratio 2.38; 95% confidence interval 1.30-4.36; p=0.005).

Conclusions: Prealbumin level on admission may be useful in the risk stratification of patients with AHF in an acute care setting.

Keywords: Acute heart failure; Inflammation; Nutrition; Prealbumin; Risk stratification.