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Serum albumin: prognostic value in patients with acute coronary syndrome
Session:
Posters - E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Speaker:
Joana Guimarães
Congress:
CPC 2021
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Joana M. Guimarães; José Pedro Barbosa; Eric Monteiro; Diogo Fernandes; Gonçalo Costa; João Rosa; Gustavo Campos; Ana Sofia Martinho; José Paulo Almeida; André Azul Freitas; Cátia Ferreira; James Milner; João Ferreira; Carolina Lourenço; Graça Castro; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction: </strong>Albumin is a negative acute-phase reactant. Therefore its levels decrease during proinflammatory states like cardiovascular disease. According to Starling’s law, low plasma oncotic pressure related to hypoalbuminemia induces a fluid shift from the intravascular to the interstitial space, which may facilitate the onset of heart failure (HF). In this study we aim to assess if serum albumin levels at admission have prognostic value in patients with acute coronary syndrome (ACS).</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="color:#000000"><strong>Methods: </strong><span style="font-family:Calibri,sans-serif">This is a retrospective observational study of patients admitted for ACS in a single coronary intensive unit. Patients were divided in two groups, based on their serum albumin levels (hypoalbuminemia: <3,5 mg/dl and normal albumin: </span><span style="font-family:Symbol">≥</span><span style="font-family:Calibri,sans-serif">3.5 mg/dl). Clinical, analytical and echocardiographic characteristics were evaluated in both groups. The outcomes considered were new-onset HF and all-cause mortality. Unadjusted logistic regression analyses were performed separately to assess the development of new-onset HF. Univariate Cox regression analysis were performed to assess all-cause mortality. Then, the covariates included in the multivariate analysis were those associated with the development of new-onset HF and all-cause mortality in the respective univariate analyses. Kaplan-Meier survival curves were used to compare the unadjusted survival curves of the two groups.</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="color:#000000"><strong>Results: </strong><span style="font-family:Calibri,sans-serif">A total of 203 patients were enrolled.</span><strong> </strong><span style="font-family:Calibri,sans-serif">Median age was 68 years-old (IQR 60-78), 75.9% were males, 14.8% had hypoalbuminemia and the median follow-up was 27 (IQR 20-34) months. Only 18.7% of the patients had previous history of HF. Patients with hypoalbuminemia were older and had a higher Killip class (KK) at admission. In the univariate regression analysis, hypoalbuminemia predicted death by all causes (HR 5.45; 95% CI 2.73-10.91; P<0.001) but did not predict new-onset HF (OR 2.48; 95% CI 0.09-6.95; p=0.083). Adjusted multivariate Cox analysis (including age, dyslipidemia, chronic kidney disease, history of HF, serum creatinine, LVEF and KK </span><span style="font-family:Symbol">≥</span><span style="font-family:Calibri,sans-serif">2), showed that hypoalbuminemia was an independent predictor of mortality by all causes (HR 2.44; 95% CI 1.11-5.38: P=0.027) in patients with ACS, as well as age and dyslipidemia.</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion:</strong> In ACS, hypoalbuminemia is a valuable predictor of all-cause mortality, independent of other risk-factors, but it doesn’t predict new-onset heart failure. The associated inflammatory state is a possible mechanism underlying hypoalbuminemia in this clinical setting. Therefore, understanding the connection between inflammation, hypoalbuminemia and poor outcomes in ACS could be useful to identify at-risk patients.</span></span></span></p>
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