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Armentaro G, Condoleo V, Pastura CA, Grasso M, Frasca A, Martire D, Cassano V, Maio R, Bonfrate L, Pastori D, Montalcini T, Andreozzi F, Sesti G, Violi F, Sciacqua A. Prognostic role of serum albumin levels in patients with chronic heart failure. Intern Emerg Med 2024; 19:1323-1333. [PMID: 38776047 PMCID: PMC11364577 DOI: 10.1007/s11739-024-03612-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/09/2024] [Indexed: 08/31/2024]
Abstract
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.
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Affiliation(s)
- Giuseppe Armentaro
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, 88100, Catanzaro, Italy
| | - Valentino Condoleo
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, 88100, Catanzaro, Italy
| | - Carlo Alberto Pastura
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, 88100, Catanzaro, Italy
| | - Maria Grasso
- Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza Delle Cliniche N.2, 90127, Palermo, Italy
| | - Angelo Frasca
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, 88100, Catanzaro, Italy
| | - Domenico Martire
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, 88100, Catanzaro, Italy
| | - Velia Cassano
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, 88100, Catanzaro, Italy
| | - Raffaele Maio
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, 88100, Catanzaro, Italy
| | - Leonilde Bonfrate
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - Daniele Pastori
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Tiziana Montalcini
- Department of Clinical and Experimental Medicine, University Magna Grecia, 88100, Catanzaro, Italy
- Research Center for the Prevention and Treatment of Metabolic Diseases (CR-METDIS), University Magna Græcia, 88100, Catanzaro, Italy
| | - Francesco Andreozzi
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, 88100, Catanzaro, Italy
- Research Center for the Prevention and Treatment of Metabolic Diseases (CR-METDIS), University Magna Græcia, 88100, Catanzaro, Italy
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, University Rome-Sapienza, Viale Regina Elena N. 324, 00161, Rome, Italy
| | - Francesco Violi
- Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Angela Sciacqua
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, 88100, Catanzaro, Italy.
- Research Center for the Prevention and Treatment of Metabolic Diseases (CR-METDIS), University Magna Græcia, 88100, Catanzaro, Italy.
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Biancucci M, Barbiero R, Pennella B, Cannatà A, Ageno W, Tangianu F, Maresca AM, Dentali F, Bonaventura A. Hypoalbuminaemia and heart failure: A practical review of current evidence. Eur J Heart Fail 2024. [PMID: 38962822 DOI: 10.1002/ejhf.3363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 04/23/2024] [Accepted: 04/29/2024] [Indexed: 07/05/2024] Open
Abstract
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.
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Affiliation(s)
- Marta Biancucci
- Department of Internal Medicine, Medical Center, S.C. Medicina Generale 1, Ospedale di Circolo and Fondazione Macchi, ASST Sette Laghi, Varese, Italy
| | - Riccardo Barbiero
- Internal Medicine Residency Program, School of Medicine, University of Insubria, Varese, Italy
| | - Benedetta Pennella
- Department of Internal Medicine, Medical Center, S.C. Medicina Generale 1, Ospedale di Circolo and Fondazione Macchi, ASST Sette Laghi, Varese, Italy
| | - Antonio Cannatà
- King's College London British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine & Sciences, London, UK
- King's College Hospital NHS Foundation Trust, London, UK
| | - Walter Ageno
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Flavio Tangianu
- Department of Internal Medicine, Medical Center, S.C. Medicina Generale 1, Ospedale di Circolo and Fondazione Macchi, ASST Sette Laghi, Varese, Italy
| | | | - Francesco Dentali
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Aldo Bonaventura
- Department of Internal Medicine, Medical Center, S.C. Medicina Generale 1, Ospedale di Circolo and Fondazione Macchi, ASST Sette Laghi, Varese, Italy
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Wang S, Xue Z, Su D, Ji L, Gao Y. Association between preoperative albumin and length of hospital stay in non-cardiac surgery patients with pulmonary hypertension: A secondary retrospective analysis. Medicine (Baltimore) 2024; 103:e38442. [PMID: 38847677 PMCID: PMC11155595 DOI: 10.1097/md.0000000000038442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/10/2024] [Indexed: 06/10/2024] Open
Abstract
To explore the risk factors affecting the length of hospital stay (LOS) as well as to examine the relationship between preoperative serum albumin levels and LOS following non-cardiac, non-obstetric surgery in patients with pulmonary hypertension (PHTN). This study represents a secondary retrospective analysis based on 287 non-cardiac, non-obstetric procedures performed on 195 PTHN patients at a single institution in the USA between 2007 and 2013. The primary outcome was the LOS. We conducted a multiple logistic regression analysis to compare the LOS between the 2 groups, divided at a serum albumin level of 3.5 g/dL. After adjusting for multiple covariates, the ORs for the long length of stay (LOS > 7 days) for the high group(albumin > 3.5 g/dL) compared with the low group (albumin ≤ 3.5 g/dL) were 0.35 (95%CI: 0.21~0.6), 0.41 (95%CI: 0.22 ~0.76), 0.41 (95%CI: 0.18~0.94) from model 2 to model 4. The stratified analysis results indicate that these findings are stable (p for trend > 0.05). In this study, it was observed that low levels of preoperative albumin were associated with an increased risk of prolonged hospital stay after non-cardiac, non-obstetric surgery in patients with PHTN. This implies that optimizing preoperative nutrition could potentially reduce the LOS for non-cardiac, non-obstetric surgery in patients with PHTN.
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Affiliation(s)
- Shu Wang
- Affiliated Hospital 6 of Nantong University, Department of Anesthesiology, Yancheng City, Jiangsu Province, China
- Affiliated Yancheng Third People’s Hospital, Department of Anesthesiology, Yancheng City, Jiangsu Province, China
| | - Zhouya Xue
- Affiliated The First people's Hospital of Yancheng, Department of Anesthesiology, Yancheng City, Jiangsu Province, China
- Affiliated The Yancheng Clinical College of Xuzhou Medical University, Department of Anesthesiology, Yancheng City, Jiangsu Province, China
| | - Dan Su
- Affiliated Hospital 6 of Nantong University, Department of Anesthesiology, Yancheng City, Jiangsu Province, China
- Affiliated Yancheng Third People’s Hospital, Department of Anesthesiology, Yancheng City, Jiangsu Province, China
| | - Lin Ji
- Affiliated Hospital 6 of Nantong University, Department of Anesthesiology, Yancheng City, Jiangsu Province, China
- Affiliated Yancheng Third People’s Hospital, Department of Anesthesiology, Yancheng City, Jiangsu Province, China
| | - Yuanyuan Gao
- Affiliated Hospital 6 of Nantong University, Department of Anesthesiology, Yancheng City, Jiangsu Province, China
- Affiliated Yancheng Third People’s Hospital, Department of Anesthesiology, Yancheng City, Jiangsu Province, China
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Pay L, Yumurtaş AÇ, Tezen O, Çetin T, Eren S, Çınar T, Hayıroğlu Mİ. Prognostic value of serum albumin in heart failure patients with cardiac resynchronization therapy. Biomark Med 2024; 18:363-371. [PMID: 39041845 DOI: 10.1080/17520363.2024.2347200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 04/22/2024] [Indexed: 07/24/2024] Open
Abstract
Aim: There is a lack of data about the association between admission serum albumin levels and long-term mortality in heart failure (HF) patients with cardiac resynchronization therapy defibrillators (CRT-D). We aim to investigate this connection in HF patients with CRT-D. Methods: The study population consisted of 477 HF patients with CRT-D. The cohort was divided into three groups according to albumin values, and the relationship between these groups and long-term mortality were evaluated. Results: Long-term all-cause mortality (HR: 3.32, 95% CI: 2.12-6.84), appropriate (HR: 4.44, 95% CI: 2.44-8.06) and inappropriate (HR: 2.95, 95% CI: 1.88-6.02) shocks were higher in the low albumin group. Conclusion: Low albumin levels are associated with the long-term mortality and appropriate shock treatment in HF patients with CRT-D.
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Affiliation(s)
- Levent Pay
- Department of Cardiology, Ardahan State Hospital, 75000, Ardahan, Turkey
| | | | - Ozan Tezen
- Department of Cardiology, Bayrampasa State Hospital, 34040, Istanbul, Turkey
| | - Tuğba Çetin
- Department of Cardiology, Dr Siyami Ersek Thoracic & Cardiovascular Surgery Training Hospital, 34668, Istanbul, Turkey
| | - Semih Eren
- Department of Cardiology, Dr Siyami Ersek Thoracic & Cardiovascular Surgery Training Hospital, 34668, Istanbul, Turkey
| | - Tufan Çınar
- Department of Medicine, University of Maryland Medical Center Midtown Campus, MD 21201, USA
| | - Mert İlker Hayıroğlu
- Department of Cardiology, Dr Siyami Ersek Thoracic & Cardiovascular Surgery Training Hospital, 34668, Istanbul, Turkey
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Li H, Wang S, Yang S, Liu S, Song Y, Chen S, Li X, Li Z, Li R, Zhao Y, Zhu Q, Ning C, Liu M, He Y. Multiple cardiometabolic diseases enhance the adverse effects of hypoalbuminemia on mortality among centenarians in China: a cohort study. Diabetol Metab Syndr 2023; 15:231. [PMID: 37957767 PMCID: PMC10644513 DOI: 10.1186/s13098-023-01201-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Although hypoalbuminemia was associated with high risk of mortality in community-dwelling older adults, as well as in the hospitalized older adults, little is known among centenarians. And there are limited data on whether having cardiometabolic diseases (CMDs) is associated with additive effects. METHODS Baseline examinations including a determination of albumin levels were performed in 1002 Chinese centenarians from January 2014 through to December 2016, and the survival status was subsequently ascertained until 31 May 2021. Cox proportional risk model was performed to assess the risk of all-cause mortality associated with albumin levels and hypoalbuminemia combined with CMDs. RESULTS Of 1002 participants included in the analysis, the mean level of albumin was 38.5 g/L (± standard deviation, 4.0 g/L), and 174 (17.4%) had hypoalbuminemia (albumin < 35 g/L). The multivariable analyses showed that albumin level was negatively associated with all-cause mortality (Ptrend < 0.05). Compared to normoalbuminemia, hypoalbuminemia was associated with an increased mortality risk in the overall participants (hazard ratio [HR]: 1.55, 95% confidence interval [CI]: 1.22-1.97). Furthermore, the HR (95% CI) of hypoalbuminemia combined with multiple CMDs was 2.15 (1.14-4.07). There was evidence of an additive deleterious dose effect of an increasing number of CMDs (Ptrend = 0.001). CONCLUSIONS Hypoalbuminemia is associated with an increased risk of all-cause mortality in Chinese centenarians, and this risk is more pronounced among centenarians with multiple cardiometabolic diseases. Our findings suggest that older adults with hypoalbuminemia, especially comorbid multiple CMDs warrant early identification and management.
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Affiliation(s)
- Haowei Li
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second Medical Center of Chinese, PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Shengshu Wang
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second Medical Center of Chinese, PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
- Department of Healthcare, Agency for Offices Administration, Central Military Commission, People's Republic of China, Beijing, 100082, China
| | - Shanshan Yang
- Department of Disease Prevention and Control, Chinese PLA General Hospital, The 1St Medical Center, Beijing, 100853, China
| | - Shaohua Liu
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second Medical Center of Chinese, PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Yang Song
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second Medical Center of Chinese, PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
- Special Combat Detachment of Xinjiang Armed Police Crops, Health Corps, Aksu, 843000, China
| | - Shimin Chen
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second Medical Center of Chinese, PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Xuehang Li
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second Medical Center of Chinese, PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Zhiqiang Li
- Chinese PLA Center for Disease Control and Prevention, Beijing, 100071, China
| | - Rongrong Li
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second Medical Center of Chinese, PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Yali Zhao
- Central Laboratory of Hainan Hospital, Chinese PLA General Hospital, Sanya, 572013, China
| | - Qiao Zhu
- Central Laboratory of Hainan Hospital, Chinese PLA General Hospital, Sanya, 572013, China
| | - Chaoxue Ning
- Central Laboratory of Hainan Hospital, Chinese PLA General Hospital, Sanya, 572013, China
| | - Miao Liu
- Department of anti-NBC Medicine, Graduate School of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
| | - Yao He
- Institute of Geriatrics, Beijing Key Laboratory of Aging and Geriatrics, National Clinical Research Center for Geriatrics Diseases, Second Medical Center of Chinese, PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
- State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital, 100853, Beijing, China.
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Zhang X, Zhang J, Liu F, Li W, Zhang T, Fang B, Zhang Z, Xie Q, Yang Y, Li X. Prognostic Nutritional Index (PNI) as a Predictor in Patients with Metabolic Syndrome and Heart Failure. Diabetes Metab Syndr Obes 2023; 16:2503-2514. [PMID: 37614379 PMCID: PMC10443633 DOI: 10.2147/dmso.s420924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/12/2023] [Indexed: 08/25/2023] Open
Abstract
Purpose There is a lack of research on nutritional status and poor prognosis in patients with metabolic syndrome and heart failure. This study evaluated the relationship between nutritional status as defined by the PNI and adverse outcomes in patients with metabolic syndrome and heart failure. Methods A total of 1048 heart failure patients with metabolic syndrome admitted to the Heart Center of the First Affiliated Hospital of Xinjiang Medical University from January 2015 to December 2019 were consecutively. PNI was used to assess their nutritional status. Results A total of 51.0% of the patients were in the nonmalnutrition group (PNI≥45), 27.9% were in the mild malnutrition group (40≤PNI<45), and 21.1% of patients were in the malnutrition group (PNI<40). At 36 months of follow-up, after adjusting for other confounding factors, malnutrition (PNI<40) was independently associated with all-cause death (HR: 1.787, 95% CI: 1.451-2.201, P<0.001) and cardiovascular death (HR: 1.837, 95% CI: 1.467-2.301, P<0.001). PNI showed additional prognostic predictive value when included in the established risk factor model, both for all-cause death (AUC: 0.620, 95% CI: 0.579-0.661, P<0.001) and cardiovascular death (AUC: 0.596, 95% CI: 0.555-0.636, P<0.001). Conclusion In patients with metabolic syndrome and heart failure, malnutrition assessed by PNI is an independent predictor for all-cause death and cardiovascular death, and PNI is negatively correlated with the occurrence of adverse outcomes.
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Affiliation(s)
- Xuehe Zhang
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Jixin Zhang
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Fen Liu
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Clinical Medical Research Institute, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Wenling Li
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Tong Zhang
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Binbin Fang
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Clinical Medical Research Institute, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Zhiyang Zhang
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Qian Xie
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
| | - Yining Yang
- Department of Cardiology, People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, People’s Republic of China
| | - Xiaomei Li
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, People’s Republic of China
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Petch-in P, Saokaew S, Phisalprapa P, Dilokthornsakul P. The Association of Pre-operative Serum Albumin Levels and Post-operative In-Hospital Death in Patients Undergoing Gastrointestinal Surgeries in Thailand: A Retrospective Cohort Study. Drugs Real World Outcomes 2023:10.1007/s40801-023-00364-4. [DOI: 10.1007/s40801-023-00364-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 03/29/2023] Open
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Oku S, Ikawa F, Hidaka T, Matsuda S, Ozono I, Yamaguchi S, Horie N. Association of the body mass index with poor outcome at discharge in patients with aneurysmal subarachnoid hemorrhage: a registry study. Neurosurg Rev 2023; 46:58. [PMID: 36792748 DOI: 10.1007/s10143-023-01964-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/12/2023] [Accepted: 02/05/2023] [Indexed: 02/17/2023]
Abstract
Although several studies have reported on the impact of the body mass index (BMI) on functional outcome of aneurysmal subarachnoid hemorrhage (aSAH), the relationship remains unclear. This study aimed to investigate the risk factors of poor outcome of aSAH, with particular attention to BMI. A total of 860 patients with aSAH were enrolled in our registry at Shimane Prefectural Central Hospital between 2000 and 2017, of whom 393 were included in the analysis. Basic patient characteristics, including BMI, and data related to aSAH were recorded. We conducted a univariable analysis, followed by a multivariable analysis to identify the risk factors of poor outcome, defined as a modified Rankin Scale score > 2 at discharge. We also compared our study with previous studies that reported a relationship between BMI and aSAH. Multivariable analysis revealed that age (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.07-1.12), underweight (OR, 2.36; 95% CI, 1.13-4.90), overweight (OR, 2.22; 95% CI, 1.06-4.64), World Federation of Neurosurgical Societies grade (III vs I: OR, 3.10; 95% CI, 1.03-9.35; IV vs I: OR, 8.02; 95% CI, 3.54-18.19; V vs I: OR, 13.37; 95% CI, 5.33-33.54), and symptomatic vasospasm (OR, 3.40; 95% CI, 1.73-6.70) were risk factors for poor outcome at discharge. This study showed the association of underweight (BMI < 18.5 kg/m2) and overweight (≥ 25 kg/m2) with poor outcome; therefore, both high and low BMI are associated with a poor outcome at discharge for patients with aSAH. Clinical trial registry: University Hospital Medical Information Network (UMIN000035160; date of registration: December 6, 2018).
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Affiliation(s)
- Shinichiro Oku
- Department of Neurosurgery, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan
| | - Fusao Ikawa
- Department of Neurosurgery, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan.
| | - Toshikazu Hidaka
- Department of Neurosurgery, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan
| | - Shingo Matsuda
- Department of Neurosurgery, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan
| | - Iori Ozono
- Department of Neurosurgery, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan
| | - Shuhei Yamaguchi
- Department of Neurology, Shimane Prefectural Central Hospital, Izumo, Shimane, Japan
| | - Nobutaka Horie
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Wang D, Huang S, Xu G, Wu S, Liu Z, Xu L, Hu B, Hou J. Abnormal Liver Function Tests Were Related to Short- and Long-Term Prognosis in Critically Ill Patients With Primary Pulmonary Hypertension. Front Cardiovasc Med 2022; 9:897040. [PMID: 35722097 PMCID: PMC9201025 DOI: 10.3389/fcvm.2022.897040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
AimThe aim of this study was to examine the utility of liver function tests (LFTs) in predicting the prognosis of critically ill patients with primary pulmonary hypertension (PPH) with/without liver disease.MethodsWe retrieved the Medical Information Mart for Intensive Care III (MIMIC-III) database to acquire clinical data. From the database, we recruited adult patients that were equal to or older than 18 years with primary pulmonary hypertension (PPH) discharge from intensive care unit (ICU). Then, the relationship between LFTs and duration of hospitalization and ICU stays was examined based on the Spearman correlation. The chi-square assessment was conducted to examine the correlation between LFTs and death rates. Survival curves were plotted with the aid of the Kaplan-Meier technique, and the curves were subsequently compared utilizing the log-rank test. The LFTs were identified as independent predictive variables of death according to the results of multivariable logistic regression. The specificity and sensitivity for mortality were calculated utilizing receiver operating characteristic (ROC) curves and the area under the curve (AUC).ResultsIn total, 198 patients satisfying the inclusion criteria were recruited, among which there were 23 patients with liver disease. Only ALB was correlated with the length of ICU stay in the total PPH group. ALB independently served as a risk variable for hospital mortality and 90-day mortality and was significantly associated with 90-day and 4-year survival rates in both total PPH and PPH without liver disease. AST was correlated with hospital mortality and 90-day survival curves in both total PPH and PPH without liver disease and independently served as a risk factor for hospital and 90-day mortality only in the total PPH group. ALT independently acted as a risk variable for hospital mortality and total bilirubin was correlated with hospital mortality in the total group. The diagnostic performance of the predictive model combining the LFTs was moderately good for the hospital, 90-day, and 4-year mortality. Both Modelı End-Stage ıLiverı Disease (MELD) score and albumin-bilirubin (ALBI) score were independent risk factors for short- and long-term prognosis. And they were also significantly associated with short- and long-term prognosis.ConclusionAmong critically ill patients with PPH and with or without liver illness, aberrant LFT was linked to short- and long-term prognoses.
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Affiliation(s)
- Dayu Wang
- Department of Cardiology, Guangzhou Panyu Central Hospital, Guangzhou, China
- *Correspondence: Dayu Wang,
| | - Suiqing Huang
- Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Guangtao Xu
- Forensic and Pathology Laboratory, Department of Pathology, Institute of Forensic Science, Jiaxing University, Jiaxing, China
| | - Sha Wu
- Department of Cardiology, Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Zhen Liu
- Department of Cardiology, Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Long Xu
- Forensic and Pathology Laboratory, Department of Pathology, Institute of Forensic Science, Jiaxing University, Jiaxing, China
| | - Bo Hu
- Department of Pathology and Municipal Key-Innovative Discipline of Molecular Diagnostics, Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing University, Jiaxing, China
- Bo Hu,
| | - Jian Hou
- Department of Cardiac Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Jian Hou,
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10
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Li Z, Ling Y, Yuan X, Liu X, Huang W, Chen Q, Wang J, Chen Y, Xu M, Wu B. Impact of albumin infusion on prognosis of intensive care unit patients with congestive heart failure-hypoalbuminemia overlap: a retrospective cohort study. J Thorac Dis 2022; 14:2235-2246. [PMID: 35813730 PMCID: PMC9264072 DOI: 10.21037/jtd-22-648] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/01/2022] [Indexed: 12/16/2022]
Abstract
Background Hypoalbuminemia is common in congestive heart failure (CHF) patients. Serum albumin is associated with the prognosis of CHF patients. Impact of albumin infusion on prognosis of patients with CHF-hypoalbuminemia overlap remains unclear. We retrospectively investigated the impact of albumin infusion on prognosis of intensive care unit (ICU) patients with CHF-hypoalbuminemia overlap. Methods We enrolled all patients whose diagnosis included CHF [ICD-9 (international classification of diseases 9) code =428.0] at first ICU admission from the MIMIC III (Medical Information Mart for Intensive Care III) database, and excluded those with missing serum albumin values, with serum albumin >3.4 g/dL or <18 years old. According to the exposure of albumin infusion during hospitalization, patients were stratified into non-albumin and albumin groups. Propensity-score matching (PSM) was performed (1:1 ratio) to control for baseline confounding. Outcome measures were in-hospital mortality as well as length of stay in the ICU (ICU LOS) and the hospital (hospital LOS). Results There were 3,190 eligible patients in the initial search. Patients with albumin infusion had markedly higher in-hospital mortality (36.42% vs. 21.81%, P<0.001), longer ICU LOS [median 6.93 (3.39–14.82) vs. 3.84 (1.96–8.00) days, P<0.001], and longer hospital LOS [median 17.46 (11.45–28.33) vs. 10.92 (6.81–18.00) days, P<0.001] than those without albumin infusion. The multivariate logistic regression analysis revealed that albumin infusion [odds ratio (OR), 1.509; 95% confidence interval (CI), 1.164–1.957; P=0.002] was significantly associated with increased risk of in-hospital mortality. After PSM, a cohort of 429 pairs of patients was included in the final analysis. Patients with albumin infusion had markedly higher in-hospital mortality (34.97% vs. 27.27%, P=0.015), longer ICU LOS [median 8.43 (4.33–16.28) vs. 6.43 (3.07–13.66) days, P<0.001], and longer hospital LOS [median 16.92 (11.27–28.06) vs. 13.33 (8.00–21.10) days, P<0.001] than those without albumin infusion. The multivariate logistic regression analysis revealed that albumin infusion (OR, 1.594; 95% CI, 1.143–2.223; P=0.006) was significantly associated with increased risk of in-hospital mortality. Conclusions Albumin infusion increased in-hospital mortality, ICU LOS, and hospital LOS in ICU patients with CHF-hypoalbuminemia overlap.
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Affiliation(s)
- Zexiong Li
- Department of Cardiovascular Medicine, Jieyang People's Hospital, Jieyang, China
| | - Yesheng Ling
- Department of Cardiovascular Medicine, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaosi Yuan
- Department of Rehabilitation Medicine, Jieyang People's Hospital, Jieyang, China
| | - Xiao Liu
- Department of Information Center, Jieyang People's Hospital, Jieyang, China
| | - Weipeng Huang
- Department of Cardiovascular Medicine, Jieyang People's Hospital, Jieyang, China
| | - Qian Chen
- Department of Cardiovascular Medicine, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiafu Wang
- Department of Cardiovascular Medicine, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yangbo Chen
- Department of Cardiovascular Medicine, Jieyang People's Hospital, Jieyang, China
| | - Mingwei Xu
- Department of Cardiovascular Medicine, Jieyang People's Hospital, Jieyang, China
| | - Bingyuan Wu
- Department of Cardiovascular Medicine, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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11
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Klang E, Soffer S, Zimlichman E, Zebrowski A, Glicksberg BS, Grossman E, Reich DL, Freeman R, Levin MA. Synergistic effect of hypoalbuminaemia and hypotension in predicting in-hospital mortality and intensive care admission: a retrospective cohort study. BMJ Open 2021; 11:e050216. [PMID: 34706952 PMCID: PMC8552132 DOI: 10.1136/bmjopen-2021-050216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 09/24/2021] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE Hypoalbuminaemia is an important prognostic factor. It may be associated with poor nutritional states, chronic heart and kidney disease, long-standing infection and cancer. Hypotension is a hallmark of circulatory failure. We evaluated hypoalbuminaemia and hypotension synergism as predictor of in-hospital mortality and intensive care unit (ICU) admission. DESIGN We retrospectively analysed emergency department (ED) visits from January 2011 to December 2019. SETTING Data were retrieved from five Mount Sinai health system hospitals, New York. PARTICIPANTS We included consecutive ED patients ≥18 years with albumin measurements. PRIMARY AND SECONDARY OUTCOME MEASURES Clinical outcomes were in-hospital mortality and ICU admission. The rates of these outcomes were stratified by systolic blood pressure (SBP) (<90 vs ≥90 mm Hg) and albumin levels. Variables included demographics, presenting vital signs, comorbidities (measured as ICD codes) and other common blood tests. Multivariable logistic regression models analysed the adjusted OR of different levels of albumin and SBP for predicting ICU admission and in-hospital mortality. The models were adjusted for demographics, vital signs, comorbidities and common laboratory results. Patients with albumin 3.5-4.5 g/dL and SBP ≥90 mm Hg were used as reference. RESULTS The cohort included 402 123 ED arrivals (27.9% of total adult ED visits). The rates of in-hospital mortality, ICU admission and overall admission were 1.7%, 8.4% and 47.1%, respectively. For SBP <90 mm Hg and albumin <2.5 g/dL, mortality and ICU admission rates were 34.0% and 40.6%, respectively; for SBP <90 mm Hg and albumin ≥2.5 g/dL 8.2% and 24.1%, respectively; for SBP ≥90 mm Hg and albumin <2.5 g/dL 11.4% and 18.6%, respectively; for SBP ≥90 mm Hg and albumin 3.5-4.5 g/dL 0.5% and 6.4%, respectively. Multivariable analysis showed that in patients with hypotension and albumin <2.5 g/dL the adjusted OR for in-hospital mortality was 37.1 (95% CI 32.3 to 42.6), and for ICU admission was 5.4 (95% CI 4.8 to 6.1). CONCLUSION Co-occurrence of hypotension and hypoalbuminaemia is associated with poor hospital outcomes.
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Affiliation(s)
- Eyal Klang
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Shelly Soffer
- Internal Medicine B, Assuta Medical Center, Ashdod, Israel
- Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Eyal Zimlichman
- Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
- Hospital management, Sheba Medical Center, Tel Hashomer, Israel
| | - Alexis Zebrowski
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Benjamin S Glicksberg
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - E Grossman
- Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
- Internal medicine Wing, Sheba Medical Center, Tel Hashomer, Israel
| | - David L Reich
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Robert Freeman
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Matthew A Levin
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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12
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Nickel NP, Galura GM, Zuckerman MJ, Hakim MN, Alkhateeb H, Mukherjee D, Austin ED, Heresi GA. Liver abnormalities in pulmonary arterial hypertension. Pulm Circ 2021; 11:20458940211054304. [PMID: 34707859 PMCID: PMC8544777 DOI: 10.1177/20458940211054304] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/13/2021] [Indexed: 12/17/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a cardiopulmonary disease with high mortality. In recent years, it has been recognized that PAH is a multi-organ system disease, involving the systemic circulation, kidneys, skeletal muscles, and the central nervous system, among others. Right heart failure produces congestive hepatopathy, a disease state that has direct consequences on liver biochemistry, histology, and systemic glucose and lipid metabolism. This article aims to summarize the consequences of congestive hepatopathy with an emphasis on liver biochemistry, histology, and PAH-targeted therapy. Furthermore, PAH-specific changes in glucose and lipid metabolism will be discussed.
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Affiliation(s)
- Nils P. Nickel
- Division of Pulmonary and Critical Care Medicine, Texas Tech
University Health Sciences Center, El Paso, TX, USA
| | - Gian M. Galura
- Division of Gastroenterology, Texas Tech University Health
Sciences Center, El Paso, TX, USA
| | - Marc J. Zuckerman
- Division of Gastroenterology, Texas Tech University Health
Sciences Center, El Paso, TX, USA
| | - M. Nawar Hakim
- Department of Pathology, Texas Tech University Health Sciences
Center, El Paso, TX, USA
| | - Haider Alkhateeb
- Division of Cardiovascular Medicine, Texas Tech University
Health Sciences Center, El Paso, TX, USA
| | - Debabrata Mukherjee
- Division of Cardiovascular Medicine, Texas Tech University
Health Sciences Center, El Paso, TX, USA
| | - Eric D. Austin
- Division of Pediatric Pulmonary Medicine, Vanderbilt University,
Nashville, TN, USA
| | - Gustavo A. Heresi
- Division of Pulmonary and Critical Care Medicine, Cleveland
Clinic, OH, USA
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13
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Changes in prognostic nutritional index during hospitalization and outcomes in patients with acute heart failure. Heart Vessels 2021; 37:61-68. [PMID: 34131778 DOI: 10.1007/s00380-021-01888-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 06/04/2021] [Indexed: 10/21/2022]
Abstract
Although the prognostic nutritional index (PNI) is reported as a prognosticator in patients with heart failure (HF), that is evaluated usually on one occasion, and any changes in PNI during hospitalization are not considered. This study aimed to assess between changes in the PNI during hospitalization and outcomes in patients with acute HF. We enrolled 141 patients (median age, 84 years, 75 male) admitted to our hospital for the treatment of acute HF. The PNI was calculated on admission and at discharge based on the original report. According to the PNI change during hospitalization, patients were classified as either improved (PNI at discharge ≥ PNI on admission) or deteriorated (PNI at discharge < PNI on admission). Primary outcomes were all-cause death or unplanned hospitalization due to HF within the first year. Forty-nine events occurred (19 deaths, 30 HF hospitalizations). The event-free survival rate determined by Kaplan-Meier analysis was significantly higher in patients in the improved group (log-rank test, P < 0.0001), regardless of the PNI value on admission. Multivariate analysis showed that younger age (HR 1.06, 95% CI 1.01-1.11, P = 0.016), higher body mass index (HR 0.90, 95% CI 0.82-0.98, P = 0.021) and the PNI in the improved group (HR 0.30, 95% CI 0.14-0.57, P = 0.0006) were independently associated with favorable outcomes. In conclusion, changes in nutritional status during hospitalization, evaluated using the PNI on admission and at discharge, were independently associated with 1-year outcomes in patients with acute HF.
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14
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El Iskandarani M, El Kurdi B, Murtaza G, Paul TK, Refaat MM. Prognostic role of albumin level in heart failure: A systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e24785. [PMID: 33725833 PMCID: PMC7969328 DOI: 10.1097/md.0000000000024785] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 01/26/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Hypoalbuminemia (HA) is common in HF, however, its pathophysiology and clinical implications are poorly understood. While multiple studies have been published in the past decade investigating the role of serum albumin in HF, there is still no consensus on the prognostic value of this widely available measure. The objective of this study is to assess the prognostic role of albumin in heart failure (HF) patient. METHODS Unrestricted searches of MEDLINE, EMBASE, Cochrane databases were performed. The results were screened for relevance and eligibility criteria. Relevant data were extracted and analyzed using Comprehensive Meta-Analysis software. The Begg and Mazumdar rank correlation test was utilized to evaluate for publication bias. RESULTS A total of 48 studies examining 44,048 patients with HF were analyzed. HA was found in 32% (95% confidence interval [CI] 28.4%-37.4%) HF patients with marked heterogeneity (I2 = 98%). In 10 studies evaluating acute HF, in-hospital mortality was almost 4 times more likely in HA with an odds ratios (OR) of 3.77 (95% CI 1.96-7.23). HA was also associated with a significant increase in long-term mortality (OR: 1.5; 95% CI: 1.36-1.64) especially at 1-year post-discharge (OR: 2.44; 95% CI: 2.05-2.91; I2 = 11%). Pooled area under the curve (AUC 0.73; 95% CI 0.67-0.78) was comparable to serum brain natriuretic peptide (BNP) in predicting mortality in HF patients. CONCLUSION Our results suggest that HA is associated with significantly higher in-hospital mortality as well as long-term mortality with a predictive accuracy comparable to that reported for serum BNP. These findings suggest that serum albumin may be useful in determining high-risk patients.
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Affiliation(s)
| | | | - Ghulam Murtaza
- Cardiology Division, East Tennessee State University, Johnson City, Tennessee
| | - Timir K. Paul
- Cardiology Division, East Tennessee State University, Johnson City, Tennessee
| | - Marwan M. Refaat
- Cardiology Division, American University of Beirut Faculty of Medicine and Medical Center, Beirut, Lebanon
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15
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Kato T, Yaku H, Morimoto T, Inuzuka Y, Tamaki Y, Ozasa N, Yamamoto E, Yoshikawa Y, Kitai T, Taniguchi R, Iguchi M, Kato M, Takahashi M, Jinnai T, Ikeda T, Nagao K, Kawai T, Komasa A, Nishikawa R, Kawase Y, Morinaga T, Kawato M, Seko Y, Shiba M, Toyofuku M, Furukawa Y, Ando K, Kadota K, Sato Y, Kuwahara K, Kimura T. Association of an increase in serum albumin levels with positive 1-year outcomes in acute decompensated heart failure: A cohort study. PLoS One 2020; 15:e0243818. [PMID: 33370299 PMCID: PMC7769473 DOI: 10.1371/journal.pone.0243818] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/27/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Despite the prognostic importance of hypoalbuminemia, the prognostic implication of a change in albumin levels has not been fully investigated during hospitalization in patients with acute decompensated heart failure (ADHF). METHODS Using the data from the Kyoto Congestive Heart Failure registry on 3160 patients who were discharged alive for acute heart failure hospitalization and in whom the change in albumin levels was calculated at discharge, we evaluated the association with an increase in serum albumin levels from admission to discharge and clinical outcomes by a multivariable Cox hazard model. The primary outcome measure was a composite of all-cause death or hospitalization for heart failure. FINDINGS Patients with increased albumin levels (N = 1083, 34.3%) were younger and less often had smaller body mass index and renal dysfunction than those with no increase in albumin levels (N = 2077, 65.7%). Median follow-up was 475 days with a 96% 1-year follow-up rate. Relative to the group with no increase in albumin levels, the lower risk of the increased albumin group remained significant for the primary outcome measure (hazard ratio: 0.78, 95% confidence interval: 0.69-0.90: P = 0.0004) after adjusting for confounders including baseline albumin levels. When stratified by the quartiles of baseline albumin levels, the favorable effect of increased albumin was more pronounced in the lower quartiles of albumin levels, but without a significant interaction effect (interaction P = 0.49). CONCLUSIONS Independent of baseline albumin levels, an increase in albumin during index hospitalization was associated with a lower 1-year risk for a composite of all-cause death and hospitalization in patients with acute heart failure.
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Affiliation(s)
- Takao Kato
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hidenori Yaku
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan
| | - Yasutaka Inuzuka
- Department of Cardiovascular Medicine, Shiga General Hospital, Shiga, Japan
| | - Yodo Tamaki
- Division of Cardiology, Tenri Hospital, Nara, Japan
| | - Neiko Ozasa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Erika Yamamoto
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yusuke Yoshikawa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Ryoji Taniguchi
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Moritake Iguchi
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Masashi Kato
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | | | - Toshikazu Jinnai
- Department of Cardiology, Japanese Red Cross Otsu Hospital, Shiga, Japan
| | - Tomoyuki Ikeda
- Department of Cardiology, Hikone Municipal Hospital, Shiga, Japan
| | - Kazuya Nagao
- Department of Cardiology, Osaka Red Cross Hospital, Osaka, Japan
| | - Takafumi Kawai
- Department of Cardiology, Kishiwada City Hospital, Osaka, Japan
| | - Akihiro Komasa
- Department of Cardiology, Kansai Electric Power Hospital, Osaka, Japan
| | - Ryusuke Nishikawa
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Yuichi Kawase
- Department of Cardiology, Kurashiki Central Hospital, Okayama, Japan
| | - Takashi Morinaga
- Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Mitsunori Kawato
- Department of Cardiology, Kobe City Nishi-Kobe Medical Center, Hyogo, Japan
| | | | - Masayuki Shiba
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Mamoru Toyofuku
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Kazushige Kadota
- Department of Cardiology, Kurashiki Central Hospital, Okayama, Japan
| | - Yukihito Sato
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University Graduate School of Medicine, Matsumoto, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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16
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Moramarco S, Morciano L, Morucci L, Messinese M, Gualtieri P, Carestia M, Ciccacci F, Orlando S, Buonomo E, Legramante JM, De Lorenzo A, Palombi L. Epidemiology of Hypoalbuminemia in Hospitalized Patients: A Clinical Matter or an Emerging Public Health Problem? Nutrients 2020; 12:nu12123656. [PMID: 33261019 PMCID: PMC7760225 DOI: 10.3390/nu12123656] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 12/14/2022] Open
Abstract
Serum albumin levels are strongly associated with the morbidity, prognosis, and mortality rates of patients with hypoalbuminemia, which is a frequent problem during hospitalization. An observational retrospective study was carried out to analyze changes in albumin levels in hospitalized patients at the “Fondazione Policlinico Tor Vergata—PTV” in 2018. The prevalence of preexisting hypoalbuminemia at the time of discharge from hospital was investigated using a sample of 9428 patients. Information was collected from the discharge files recorded in the central informatics system of the hospital. Analysis of albumin levels at admission and at discharge was conducted by classes of albuminemia and then stratified by age. At the time of admission, hypoalbuminemia was found to be present in more than half of the sample, with no sex differences. The serum albumin level tended to decrease with age, with pathologic levels appearing from 50 years and progressive worsening thereafter. The condition of marked and mild hypoalbuminemia was more prevalent in patients over 65 years of age. Our findings suggest that hypoalbuminemia should be considered a dangerous condition in itself and a serious public health problem. We aimed to emphasize the role of albumin as useful marker of the in-hospital malnutrition and frailty, to be integrated in the routinely assessment of patients for reconsidering ad hoc healthcare pathways after discharge from hospital, especially when dealing with fragile populations.
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Affiliation(s)
- Stefania Moramarco
- Section of Hygiene and Public Health, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1-00133 Rome, Italy; (L.M.); (L.M.); (M.M.); (M.C.); (S.O.); (E.B.); (L.P.)
- Correspondence:
| | - Laura Morciano
- Section of Hygiene and Public Health, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1-00133 Rome, Italy; (L.M.); (L.M.); (M.M.); (M.C.); (S.O.); (E.B.); (L.P.)
| | - Luca Morucci
- Section of Hygiene and Public Health, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1-00133 Rome, Italy; (L.M.); (L.M.); (M.M.); (M.C.); (S.O.); (E.B.); (L.P.)
| | - Mario Messinese
- Section of Hygiene and Public Health, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1-00133 Rome, Italy; (L.M.); (L.M.); (M.M.); (M.C.); (S.O.); (E.B.); (L.P.)
| | - Paola Gualtieri
- Section of Clinical Nutrition and Nutrigenomics, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1-00133 Rome, Italy; (P.G.); (A.D.L.)
| | - Mariachiara Carestia
- Section of Hygiene and Public Health, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1-00133 Rome, Italy; (L.M.); (L.M.); (M.M.); (M.C.); (S.O.); (E.B.); (L.P.)
| | - Fausto Ciccacci
- Unicamillus, International Medical University in Rome, Via di Sant’Alessandro, 8-00131 Rome, Italy;
| | - Stefano Orlando
- Section of Hygiene and Public Health, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1-00133 Rome, Italy; (L.M.); (L.M.); (M.M.); (M.C.); (S.O.); (E.B.); (L.P.)
| | - Ersilia Buonomo
- Section of Hygiene and Public Health, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1-00133 Rome, Italy; (L.M.); (L.M.); (M.M.); (M.C.); (S.O.); (E.B.); (L.P.)
| | - Jacopo Maria Legramante
- Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier, 1-00133 Rome, Italy;
| | - Antonino De Lorenzo
- Section of Clinical Nutrition and Nutrigenomics, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1-00133 Rome, Italy; (P.G.); (A.D.L.)
| | - Leonardo Palombi
- Section of Hygiene and Public Health, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1-00133 Rome, Italy; (L.M.); (L.M.); (M.M.); (M.C.); (S.O.); (E.B.); (L.P.)
- Unicamillus, International Medical University in Rome, Via di Sant’Alessandro, 8-00131 Rome, Italy;
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17
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Akirov A, Gorshtein A, Adler‐Cohen C, Steinmetz T, Shochat T, Shimon I. Low serum albumin levels predict short‐ and long‐term mortality risk in patients hospitalised to general surgery wards. Intern Med J 2020; 50:977-984. [DOI: 10.1111/imj.14708] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/10/2019] [Accepted: 11/09/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Amit Akirov
- Department of Medicine, Institute of Endocrinology, Beilinson Hospital Petah Tikva Israel
- Department of Medicine, Sackler School of Medicine, Tel Aviv University Tel Aviv Israel
- Department of Endocrine OncologyPrincess Margaret Cancer Centre Toronto Ontario Canada
| | - Alexander Gorshtein
- Department of Medicine, Institute of Endocrinology, Beilinson Hospital Petah Tikva Israel
- Department of Medicine, Sackler School of Medicine, Tel Aviv University Tel Aviv Israel
| | - Chagit Adler‐Cohen
- Department of Medicine, Institute of Endocrinology, Beilinson Hospital Petah Tikva Israel
- Department of Medicine, Sackler School of Medicine, Tel Aviv University Tel Aviv Israel
| | - Tali Steinmetz
- Department of Medicine, Sackler School of Medicine, Tel Aviv University Tel Aviv Israel
- Department of Nephrology and HypertensionBeilinson Hospital Petah Tikva Israel
| | - Tzipora Shochat
- Statistical Consulting Unit, Rabin Medical CenterBeilinson Hospital Petah Tikva Israel
| | - Ilan Shimon
- Department of Medicine, Institute of Endocrinology, Beilinson Hospital Petah Tikva Israel
- Department of Medicine, Sackler School of Medicine, Tel Aviv University Tel Aviv Israel
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18
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Lin L, Hu K, Cai S, Deng X, Shao X, Liang Y, Wang J, Zhong T, Hu Z, Lei M. Hypoproteinemia is an independent risk factor for the prognosis of severe COVID-19 patients. J Clin Biochem Nutr 2020; 67:126-130. [PMID: 33041508 PMCID: PMC7533863 DOI: 10.3164/jcbn.20-75] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/29/2020] [Indexed: 01/08/2023] Open
Abstract
Severe patients of the coronavirus disease 2019 (COVID-19) may progress rapidly to critical stage. This study aimed to identify factors useful for predicting the progress. 33 severe COVID-19 patients at the intensive care unit were included in this study. During treatment, 13 patients deteriorated and required further treatment for supporting organ function. The remaining 20 patients alleviated and were transferred to the general wards. The multivariate COX regression analyses showed that hypoproteinemia was an independent risk factor associated with deterioration of severe patients (HR, 0.763; 95% CI, 0.596 to 0.978; p = 0.033). The restricted cubic spline indicated that when HR = 1, the corresponding value of albumin is 29.6 g/L. We used the cutoff of 29.6 g/L to divide these patients. Kaplan-Meier curves showed that the survival rate of the high-albumin group was higher than that of the low-albumin group. Therefore, hypoalbuminemia may be an independent risk factor to evaluate poor prognosis of severely patients with COVID-19, especially when albumin levels were below 29.6 g/L.
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Affiliation(s)
- Liu Lin
- Department of Nephrology, Guangzhou Medical University, No. 8, Huaying Road, Guangzhou, Guangzhou 510060, China
| | - Kaiyuan Hu
- Department of Nephrology, Guangzhou Medical University, No. 8, Huaying Road, Guangzhou, Guangzhou 510060, China
| | - Shuijiang Cai
- Department of Critical Care Medicine, Guangzhou Medical University, No. 8, Huaying Road, Guangzhou, Guangzhou 510060, China
| | - Xilong Deng
- Department of Critical Care Medicine, Guangzhou Medical University, No. 8, Huaying Road, Guangzhou, Guangzhou 510060, China
| | - Xinning Shao
- Department of Nephrology, Guangzhou Medical University, No. 8, Huaying Road, Guangzhou, Guangzhou 510060, China
| | - Ying Liang
- Department of Nephrology, Guangzhou Medical University, No. 8, Huaying Road, Guangzhou, Guangzhou 510060, China
| | - Jigang Wang
- Department of Artemisinin Research Center, and Institute of Chinese Materia Medical, China Academy of Chinese Medical Sciences, No. 16, Nanxiaojie, Dongzhimennei Ave, Beijing 100700, China.,Department of Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases, Ministry of Education, Gannan Medical University, No. 1, Hexie Road, Ganzhou, Jiangxi 341000, China
| | - Tianyu Zhong
- Department of Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases, Ministry of Education, Gannan Medical University, No. 1, Hexie Road, Ganzhou, Jiangxi 341000, China.,Department of Laboratory Medicine, First Affiliated Hospital of Gannan Medical University, No. 23, Qingnian Road, Ganzhou, Jiangxi 341000, China
| | - Zhongwei Hu
- Gastroenterology, Guangzhou Eighth People's Hospital, Guangzhou Medical University, No. 8, Huaying Road, Guangzhou, Guangzhou 510060, China
| | - Ming Lei
- Department of Nephrology, Guangzhou Medical University, No. 8, Huaying Road, Guangzhou, Guangzhou 510060, China
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19
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Suzuki S, Motoki H, Kanzaki Y, Maruyama T, Hashizume N, Kozuka A, Yahikozawa K, Kuwahara K. A Predictive Model for 6-Month Mortality in Elderly Patients with Heart Failure. Int Heart J 2020; 61:325-331. [DOI: 10.1536/ihj.19-572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Sho Suzuki
- Department of Cardiovascular Medicine, Minaminagano Medical Center, Shinonoi General Hospital
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
| | - Yusuke Kanzaki
- Department of Cardiovascular Medicine, Minaminagano Medical Center, Shinonoi General Hospital
| | - Takuya Maruyama
- Department of Cardiovascular Medicine, Minaminagano Medical Center, Shinonoi General Hospital
| | - Naoto Hashizume
- Department of Cardiovascular Medicine, Minaminagano Medical Center, Shinonoi General Hospital
| | - Ayako Kozuka
- Department of Cardiovascular Medicine, Minaminagano Medical Center, Shinonoi General Hospital
| | - Kumiko Yahikozawa
- Department of Cardiovascular Medicine, Minaminagano Medical Center, Shinonoi General Hospital
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine
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20
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Kato T, Yaku H, Morimoto T, Inuzuka Y, Tamaki Y, Yamamoto E, Yoshikawa Y, Kitai T, Taniguchi R, Iguchi M, Kato M, Takahashi M, Jinnai T, Ikeda T, Nagao K, Kawai T, Komasa A, Nishikawa R, Kawase Y, Morinaga T, Su K, Kawato M, Seko Y, Inoko M, Toyofuku M, Furukawa Y, Nakagawa Y, Ando K, Kadota K, Shizuta S, Ono K, Sato Y, Kuwahara K, Ozasa N, Kimura T. Association with Controlling Nutritional Status (CONUT) Score and In-hospital Mortality and Infection in Acute Heart Failure. Sci Rep 2020; 10:3320. [PMID: 32094392 PMCID: PMC7039945 DOI: 10.1038/s41598-020-60404-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 02/12/2020] [Indexed: 12/13/2022] Open
Abstract
The high controlling nutritional status (CONUT) score that represents poor nutritional status has been acknowledged to have prognostic implications in chronic heart failure. We aimed to investigate its role in acute decompensated heart failure (ADHF). Using the data from an multicenter registry that enrolled 4056 consecutive patients hospitalized for ADHF in Japan between 2014 and 2016, we analyzed 2466 patients in whom data on the components of the CONUT score at hospital presentation were available. The decrease of lymphocyte count and total cholesterol was assigned with 0, 1, 2, and 3 points and the decrease of albumin was assigned with 0, 2, 4, and 6 points according to the severity. We defined low CONUT score as 0-4 (N = 1568) and high CONUT score as 5-9 (N = 898). The patients in the high CONUT score group were older and more likely to have a smaller body mass index than those in the low CONUT score group. The high CONUT score group was associated with higher rate of death and infection during the index hospitalization compared to the low CONUT score group (9.0% versus 4.4%, and 21.9% versus 12.7%, respectively). After adjusting for confounders, the excess risk of high relative to low CONUT score for mortality and infection was significant (OR: 1.61, 95%CI: 1.05-2.44, and OR: 1.66, 95%CI: 1.30-2.12, respectively). The effect was incremental according to the score. High CONUT score was associated with higher risk for in-hospital mortality and infection in an incremental manner in patients hospitalized for ADHF.
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Affiliation(s)
- Takao Kato
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Hidenori Yaku
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Hyogo, Japan
| | - Yasutaka Inuzuka
- Department of Cardiovascular Medicine, Shiga Medical Center for Adult, Shiga, Japan
| | - Yodo Tamaki
- Division of Cardiology, Tenri Hospital, Nara, Japan
| | - Erika Yamamoto
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yusuke Yoshikawa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Ryoji Taniguchi
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Moritake Iguchi
- National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | | | | | | | | | | | | | - Akihiro Komasa
- Kansai Electric Power Hospital, Osaka, Japan
- Shizuoka General Hospital, Shizuoka, Japan
| | | | | | | | - Kanae Su
- Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | | | | | | | | | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan
| | | | - Kenji Ando
- Kokura Memorial Hospital, Fukuoka, Japan
| | | | - Satoshi Shizuta
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Koh Ono
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yukihito Sato
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University Graduate School of Medicine, Matsumoto, Japan
| | - Neiko Ozasa
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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21
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Ancion A, Allepaerts S, Robinet S, Oury C, Pierard LA, Lancellotti P. Serum albumin level and long-term outcome in acute heart failure. Acta Cardiol 2019; 74:465-471. [PMID: 30650026 DOI: 10.1080/00015385.2018.1521557] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Objective: Hypoalbuminemia is common in heart failure (HF), especially in elderly patients. It is associated with an increased risk of death. The present study sought to examine the prognostic significance of serum albumin level in the prediction of long-term mortality in patients admitted for acute HF.Methods and results: We examined the association between albumin and hospital mortality in a cohort of 509 patients admitted for acute HF. None of the patients had infectious disease, severe arrhythmias (atrial fibrillation, ventricular tachycardia, ventricular fibrillation), required invasive ventilation or presented with acute coronary syndrome or primary valvular disease. Sixty-nine patients (14%) died during the 1-year follow-up. With multivariable analysis, haemoglobin level (p = .003), systolic blood pressure (p = .004) and serum albumin level (p = .003) emerged as independent predictors of long-term mortality. Hypoalbuminemia (<35.7 g/L) had a hazard ratio of 2.01 (95% CI 1.24-3.25) and haemoglobin of 2.6 (95% CI 1.29-5.22) for predicting long-term mortality.Conclusions: Serum albumin level measured at admission, especially if combined with anaemia, can serve as a simple prognostic factor in acute HF for predicting long-term outcome.
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Affiliation(s)
- Arnaud Ancion
- University Hospital of Liège, GIGA Cardiovascular Sciences, Acute Care Unit, Heart Failure Clinic, CHU Sart Tilman, Liège, Belgium
| | - Sophie Allepaerts
- University Hospital of Liège, Geriatric Medicine, CHU Sart Tilman, Liège, Belgium
| | - Sébastien Robinet
- University Hospital of Liège, GIGA Cardiovascular Sciences, Acute Care Unit, Heart Failure Clinic, CHU Sart Tilman, Liège, Belgium
| | - Cecile Oury
- University Hospital of Liège, GIGA Cardiovascular Sciences, Acute Care Unit, Heart Failure Clinic, CHU Sart Tilman, Liège, Belgium
| | - Luc A. Pierard
- University Hospital of Liège, GIGA Cardiovascular Sciences, Acute Care Unit, Heart Failure Clinic, CHU Sart Tilman, Liège, Belgium
| | - Patrizio Lancellotti
- University Hospital of Liège, GIGA Cardiovascular Sciences, Acute Care Unit, Heart Failure Clinic, CHU Sart Tilman, Liège, Belgium
- Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
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22
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Kolakshyapati M, Ikawa F, Abiko M, Mitsuhara T, Kinoshita Y, Takeda M, Kurisu K. Multivariate risk factor analysis and literature review of postoperative deterioration in Karnofsky Performance Scale score in elderly patients with skull base meningioma. Neurosurg Focus 2019; 44:E14. [PMID: 29606047 DOI: 10.3171/2018.1.focus17730] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Elderly patients are particularly at risk for severe morbidity following surgery. Among the various risk factors, age and skull base location of meningioma are known to be poor prognostic factors in meningioma surgery. The authors conducted this study to analyze significant preoperative risk factors in elderly patients with skull base meningioma. METHODS A total of 265 elderly patients (≥ 65 years old) with meningioma were surgically treated at the authors' institute and affiliated hospitals between 2000 and 2016, and these cases were reviewed. Among them, 57 patients with skull base meningioma were evaluated. Among the various risk factors, the authors analyzed age, sex, Karnofsky Performance Scale (KPS) score, American Society of Anesthesiologists score, and tumor size, location, and pathology. Body mass index (BMI) and serum albumin were investigated as the frailty factors. The authors also reviewed 11 surgical studies of elderly patients ≥ 60 years old with meningioma. RESULTS The mean age was 72.4 ± 5.7 years, and 42 patients were female (73.6%). The mean size of meningioma was 36.6 ± 14.8 mm at the maximum diameter, and the mean follow-up period was 31.1 ± 31.5 months. (The continuous variables are expressed as the mean ± SD.) Histopathological investigation revealed a higher incidence (71.9%) of WHO Grade I. The rates of deterioration after surgery, at 3 months, and at 1 year were 33.3%, 37.3%, and 39.1%, respectively. Univariate analysis revealed location, preoperative KPS score, BMI level 2, and serum albumin level (p = 0.010, 0.017, 0.0012, and 0.0019, respectively) to be poor prognostic factors. Multivariate analysis revealed that location (p = 0.038) and BMI (p = 0.035) were risk factors for KPS score deterioration immediately after surgery. According to the 11 papers reviewed, the median rate (25th-75th percentile) of skull base-related location was 43.5% (39.6-47.75); for asymptomatic status the mean was 24%; and for mortality at 3 months and 1 year the medians were 6.3% (0.7-7.1) and 8% (4.8-9.4), respectively. CONCLUSION Careful preoperative assessment based on the frailty concept was essential for better outcome in elderly patients with skull base meningioma. The BMI is appropriate as a quantitative factor for measure of frailty, particularly in elderly individuals with skull base meningioma. Further prospective randomized controlled trials are necessary to validate frailty as a preoperative risk factor. Not only patient selection but also surgical timing was an important factor.
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23
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Gotsman I, Shauer A, Zwas DR, Tahiroglu I, Lotan C, Keren A. Low serum albumin: A significant predictor of reduced survival in patients with chronic heart failure. Clin Cardiol 2019; 42:365-372. [PMID: 30637771 PMCID: PMC6712335 DOI: 10.1002/clc.23153] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/07/2019] [Accepted: 01/11/2019] [Indexed: 01/12/2023] Open
Abstract
Background Low serum albumin is common in patients with chronic heart failure (HF). Hypothesis Albumin may have an impact on clinical outcome in HF. We evaluated the effect of albumin levels on clinical outcome in a real‐world cohort of patients with HF. Methods All patients with HF at a health maintenance organization were followed for cardiac‐related hospitalizations and death. Results A total of 5779 HF patients were included in the study; mean follow‐up was 576 days; median serum albumin was 4.0 g/dL (interquartile range 3.7‐4.2), and 12% of the patients had hypoalbuminemia (albumin<3.5 g/dL). Low albumin was associated with increasing age, higher urea and C‐reactive protein, lower sodium, hemoglobin, iron, less treatment with angiotensin‐converting enzyme inhibitor or angiotensin receptor blocker, reduced right ventricular function, and pulmonary hypertension. Cox regression analysis after adjustment for significant predictors demonstrated that decreasing quartiles of albumin was significantly associated with mortality: Lowest quartile compared to highest: hazard ratio (HR) 5.74, 95% confidence interval (CI) 4.08 to 8.07, P < 0.001. Cox regression analysis of albumin as a continuous parameter using restricted cubic splines after adjustment for significant parameters demonstrated that reduced albumin levels were directly associated with increased mortality (P < 0.001 for the adjusted model). Decreasing quartiles of albumin were also a significant predictor of increased cardiac‐related hospitalizations. A decrease in albumin on follow‐up was an independent predictor of increased mortality by Cox regression analysis: HR 2.58, 95% CI 2.12 to 3.14, P < 0.001. Conclusions Low albumin provides important information regarding several detrimental processes in HF and is a significant predictor of a worse outcome in these patients.
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Affiliation(s)
- Israel Gotsman
- Heart Institute, Hadassah University Hospital, Jerusalem, Israel.,Heart Failure Center, Clalit Health Services, Jerusalem, Israel
| | - Ayelet Shauer
- Heart Institute, Hadassah University Hospital, Jerusalem, Israel
| | - Donna R Zwas
- Heart Institute, Hadassah University Hospital, Jerusalem, Israel.,Heart Failure Center, Clalit Health Services, Jerusalem, Israel
| | - Ilgar Tahiroglu
- Heart Institute, Hadassah University Hospital, Jerusalem, Israel
| | - Chaim Lotan
- Heart Institute, Hadassah University Hospital, Jerusalem, Israel
| | - Andre Keren
- Heart Institute, Hadassah University Hospital, Jerusalem, Israel.,Heart Failure Center, Clalit Health Services, Jerusalem, Israel
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24
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Isobe N, Ikawa F, Tominaga A, Kuroki K, Sadatomo T, Mizoue T, Hamasaki O, Matsushige T, Abiko M, Mitsuhara T, Kinoshita Y, Takeda M, Kurisu K. Factors Related to Frailty Associated with Clinical Deterioration After Meningioma Surgery in the Elderly. World Neurosurg 2018; 119:e167-e173. [DOI: 10.1016/j.wneu.2018.07.080] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 07/07/2018] [Accepted: 07/09/2018] [Indexed: 11/26/2022]
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25
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Peterson EJ, Ng TMH, Patel KA, Lou M, Elkayam U. Association of admission vs. nadir serum albumin concentration with short-term treatment outcomes in patients with acute heart failure. J Int Med Res 2018; 46:3665-3674. [PMID: 29865919 PMCID: PMC6135993 DOI: 10.1177/0300060518777349] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objectives Hypoalbuminemia occurs in 25% to 76% of patients hospitalized for
acute heart failure (HF) and is associated with increased
mortality. Hypoalbuminemia may predispose patients to
intravascular volume depletion, hypotension, and acute worsening
of renal function; however, its association with treatment
outcomes during hospitalization is unknown. Methods This retrospective cohort study involved 414 adult patients
hospitalized for HF requiring intravenous diuretics. Temporal
changes in serum albumin and the association of hypoalbuminemia
with urine output, renal function changes, blood pressure, use
of intravenous vasoactive drugs, and short-term outcomes were
assessed. Results Serum albumin decreased in most patients (72%) during
hospitalization. Hypoalbuminemia was present in 29% and 50% of
patients based on the mean admission and nadir serum albumin
level, respectively. Hypoalbuminemia as assessed by the nadir
albumin level was associated with an increased risk of acute
worsening of renal function. A nadir albumin level of <3.0
g/dL remained significantly associated in the multivariate
analyses. Conclusions Serum albumin commonly decreases during hospitalization for acute
HF. Hypoalbuminemia assessed using the nadir level during
hospitalization, not the admission level, was associated with an
increased risk of acute worsening of renal function. The timing
of serum albumin measurement may influence its utility as a
biomarker.
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Affiliation(s)
- Evan J. Peterson
- University
of Southern California School
of Pharmacy, Los Angeles, CA, USA
- LAC+USC
Medical Center, Los Angeles,
CA, USA
| | - Tien M. H. Ng
- University
of Southern California School
of Pharmacy, Los Angeles, CA, USA
- LAC+USC
Medical Center, Los Angeles,
CA, USA
- Tien M. H. Ng, University of
Southern California School of Pharmacy, 1985 Zonal Avenue, Los
Angeles, CA 90089-9121, USA.
| | - Komal A. Patel
- University
of Southern California School
of Pharmacy, Los Angeles, CA, USA
| | - Mimi Lou
- University
of Southern California School
of Pharmacy, Los Angeles, CA, USA
| | - Uri Elkayam
- LAC+USC
Medical Center, Los Angeles,
CA, USA
- Division of Cardiology,
University
of Southern California Keck
School of Medicine, Los Angeles, CA, USA
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26
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Snipelisky D, Jentzer J, Batal O, Dardari Z, Mathier M. Serum albumin concentration as an independent prognostic indicator in patients with pulmonary arterial hypertension. Clin Cardiol 2018; 41:782-787. [PMID: 29604093 DOI: 10.1002/clc.22954] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 03/26/2018] [Accepted: 03/27/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Serum albumin is a strong prognostic indicator for many disease processes, yet limited data exist regarding its prognostic relationship in pulmonary arterial hypertension (PAH). Our study aims to assess the relationship of hypoalbuminemia with disease severity and mortality in this population. HYPOTHESIS Serum albumin concentrations are a predictor of outcomes in PAH. METHODS A retrospective review of all patients with World Health Organization group 1 PAH evaluated between March 2001 and August 2008 was performed. Patients were stratified into groups based on serum albumin concentration ≤3.3 g/dL (hypoalbuminemia) vs >3.3 g/dL. Clinical, hemodynamic, and survival comparisons were compared between groups using Student t test and χ2 test, followed by univariate analysis and multivariate logistic regression. RESULTS A total of 163/273 (59.7%) patients had a documented serum albumin concentration. Hypoalbuminemia was present in 41 (25.2%) patients and serum albumin ≤3.3 g/dL represented the lowest quartile of serum albumin. Patients with hypoalbuminemia had higher rates of renal dysfunction (26.8% vs 9.8%, P =0.0069) and hepatic dysfunction (29.3% vs 6.6%, P <0.001), and lower hemoglobin levels (11.6 vs 13.4 g/dL, P < 0.001). Hemodynamic and functional capacity assessments were comparable between groups. Independent predictors of mortality included low albumin levels (hazard ratio [HR]: 0.485, P = 0.008), high right atrial systolic area (HR: 1.062, P = 0.003), low Fick-derived cardiac index (HR: 1.465, P = 0.016), and high New York Heart Association functional class (HR: 1.767, P = 0.042). Patients with hypoalbuminemia demonstrated a significantly lower survival rate at latest follow-up (P = 0.01). CONCLUSIONS Lower serum albumin concentrations in patients with PAH are associated with higher mortality and can serve as a marker of disease severity in this patient population.
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Affiliation(s)
- David Snipelisky
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jacob Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Omar Batal
- The Krannert Institute of Cardiology, Indiana University School of Medicine and Indiana University Health, Indianapolis, Indiana
| | - Zeina Dardari
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Michael Mathier
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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27
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Prognostic Implications of Changes in Albumin Following Left Ventricular Assist Device Implantation in Patients With Severe Heart Failure. Am J Cardiol 2017; 120:2003-2007. [PMID: 28947307 DOI: 10.1016/j.amjcard.2017.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 08/04/2017] [Accepted: 08/08/2017] [Indexed: 11/21/2022]
Abstract
Mechanical assist devices have emerged as an established therapeutic option for patients with end-stage heart failure. Because preimplant hypoalbuminemia is a known risk factor for adverse outcomes, we hypothesized that change in albumin may be a prognostic indicator in patients with continuous-flow left ventricular assist devices (cfLVADs). This is a retrospective single-center study of patients who underwent cfLVAD implantation (HeartMate II and HeartWare HVAD) at an academic center from 2008 to 2014. After excluding those who died, were transplanted, or hospitalized during the first 3 months post-implant, albumin values were obtained and stratified by an increase or a decrease from pre-implant to 3 months post-implant on 171 (81% male, mean age 57 ± 16 years) patients (139 for the survival analysis and 90 for the hospitalization analysis). Decrease in albumin from pre-implant to 3 months after implant correlated with increased mortality (hazard ratio 2.93, confidence interval 1.57 to 5.44, p <0.01) and reduced time to next hospitalization (hazard ratio 1.70, confidence interval 1.03 to 2.81, p = 0.04). The Kaplan-Meier survival curve estimated a 49.43% 2-year survival rate in those whose albumin decreased versus 83.62% in those whose albumin increased over 3 months (p <0.01). Improved outcomes were seen in patients whose albumin normalized versus patients whose albumin remained normal over 3 months. In conclusion, our study is the first to demonstrate the importance of change in albumin from pre- to postimplant on the prognosis of cfLVAD patients. Future studies are needed to determine whether therapeutic intervention to improve albumin post-implant will prevent hospitalizations and improve outcomes.
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28
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Akirov A, Masri-Iraqi H, Atamna A, Shimon I. Low Albumin Levels Are Associated with Mortality Risk in Hospitalized Patients. Am J Med 2017; 130:1465.e11-1465.e19. [PMID: 28803138 DOI: 10.1016/j.amjmed.2017.07.020] [Citation(s) in RCA: 179] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 07/11/2017] [Accepted: 07/15/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND The aim of this study was to investigate the association of albumin levels on admission and change in levels during hospitalization with hospitalization outcomes. METHODS Historical prospective data of patients hospitalized between 2011 and 2013 were collected. Levels of albumin were classified as marked hypoalbuminemia (<2.5 mg/dL), mild hypoalbuminemia (2.5-3.5 mg/dL), normal albumin (3.5-4.5 mg/dL), and hyperalbuminemia (>4.5 mg/dL). Main outcomes were length of hospitalization, in-hospital mortality, and long-term mortality. RESULTS The cohort included 30,732 patients (mean age 67 ± 18 years, 51% male). Most patients had normal albumin levels on admission (n = 20,124, 65%), 29% of patients had hypoalbuminemia, mostly mild (n = 7,334, 24%), and 5% of patients had marked hypoalbuminemia (n = 1436). Hyperalbuminemia on admission was evident in 6% of the patients (n = 1838). Follow-up (median ± standard deviation) was 1675 ± 325 days. Compared with in-hospital mortality with normal albumin on admission (2%), mortality was higher with mild (12%) and marked hypoalbuminemia (34%) and lower with hyperalbuminemia (0.3%). Mortality rate at the end of follow-up was 29% with normal albumin levels, 67% and 83% with mild and marked hypoalbuminemia, respectively. Patients with hyperalbuminemia on admission and before discharge have the best short- and long-term survival. This pattern was similar when analyzed separately in different age groups. In patients with hypoalbuminemia on admission, normalization of albumin levels before discharge was associated with better short- and long-term survival, compared with patients with hypoalbuminemia before discharge. CONCLUSIONS Low albumin levels on admission are associated with increased short- and long-term mortality. Normalization of albumin levels before discharge was associated with lower mortality risk, compared with hypoalbuminemia before discharge.
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Affiliation(s)
- Amit Akirov
- Institute of Endocrinology, Beilinson Hospital, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Israel.
| | - Hiba Masri-Iraqi
- Institute of Endocrinology, Beilinson Hospital, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Israel
| | - Alaa Atamna
- Sackler School of Medicine, Tel Aviv University, Israel; Internal Medicine C, Beilinson Hospital, Petach Tikva, Israel
| | - Ilan Shimon
- Institute of Endocrinology, Beilinson Hospital, Petach Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Israel
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Impact of levosimendan on platelet function. Thromb Res 2017; 159:76-81. [PMID: 28987709 DOI: 10.1016/j.thromres.2017.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 09/22/2017] [Accepted: 10/01/2017] [Indexed: 11/22/2022]
Abstract
Levosimendan has been developed for treatment of severe heart failure. The favorable hemodynamic effect of levosimendan is related to its unique dual mechanism of action - increase of the contractile force of the myocardium caused by enhanced sensitivity of myofilaments to calcium combined with vasodilatation caused by the opening of adenosine triphosphate - dependent potassium channels. Due to the structural similarities to phosphodiesterase inhibitors it may partly exert its action via inhibition of phosphodiesterase inhibitors III. Inhibition of the phosphodiesterase inhibitors III leads to an increase of intracellular concentration of cyclic adenosine monophosphate causing an anti-aggregatory effect. There are some contradictory or indirect and inconclusive reports related to the impact of levosimendan on platelet function. The aim of this systematic review was to critically discuss the impact of levosimendan on platelet function according to currently available knowledge based on the findings of experimental as well as observational and randomized clinical studies.
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Wada H, Dohi T, Miyauchi K, Doi S, Naito R, Konishi H, Tsuboi S, Ogita M, Kasai T, Okazaki S, Isoda K, Suwa S, Daida H. Independent and Combined Effects of Serum Albumin and C-Reactive Protein on Long-Term Outcomes of Patients Undergoing Percutaneous Coronary Intervention. Circ J 2017; 81:1293-1300. [PMID: 28428450 DOI: 10.1253/circj.cj-17-0124] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
BACKGROUND Both inflammation and malnutrition have been reported to be closely linked to atherosclerosis, especially in patients with chronic kidney disease (CKD). The combined effects of serum albumin and C-reactive protein (CRP) on clinical outcomes after percutaneous coronary intervention (PCI) were investigated.Methods and Results:A total of 2,164 all-comer patients with coronary artery disease who underwent their first PCI and had data available for preprocedural serum albumin and hs-CRP levels between 2000 and 2011 were studied. Patients were assigned to 4 groups according to their median serum albumin and CRP levels (4.1 g/dL and 0.10 mg/dL, respectively). The incidence of major adverse cardiac events (MACE), including all-cause death and non-fatal myocardial infarction (MI), was evaluated. During a median follow-up period of 7.5 years, 331 cases of MACE (15.3%), including 270 deaths and 61 non-fatal MIs, occurred. Kaplan-Meier curves showed that the rates of MACE differed significantly among the groups (log-rank P<0.0001), even stratified by with or without CKD (both log-rank P<0.0001). After adjustment for established cardiovascular risk factors, low serum albumin with high CRP levels was associated with adverse cardiac events (hazard ratio 2.55, 95% confidence interval 1.72-3,88, P<0.0001, high albumin/low CRP group as reference). CONCLUSIONS The presence of both low serum albumin and high CRP levels conferred a synergistic adverse effect on the risk for long-term MACE in patients undergoing PCI.
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Affiliation(s)
- Hideki Wada
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Tomotaka Dohi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Katsumi Miyauchi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Shinichiro Doi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Ryo Naito
- Department of Cardiovascular Medicine, Juntendo University Urayasu Hospital
| | | | - Shuta Tsuboi
- Department of Cardiology, Juntendo University Shizuoka Hospital
| | - Manabu Ogita
- Department of Cardiology, Juntendo University Shizuoka Hospital
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Shinya Okazaki
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Kikuo Isoda
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Satoru Suwa
- Department of Cardiology, Juntendo University Shizuoka Hospital
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
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González-Pacheco H, Amezcua-Guerra LM, Sandoval J, Martínez-Sánchez C, Ortiz-León XA, Peña-Cabral MA, Bojalil R. Prognostic Implications of Serum Albumin Levels in Patients With Acute Coronary Syndromes. Am J Cardiol 2017; 119:951-958. [PMID: 28160977 DOI: 10.1016/j.amjcard.2016.11.054] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 11/29/2016] [Accepted: 11/29/2016] [Indexed: 10/20/2022]
Abstract
Hypoalbuminemia is a long-term risk factor for incident of both myocardial infarction and heart failure. We assessed whether serum albumin levels at admission are associated with new-onset heart failure and in-hospital mortality in patients with acute coronary syndrome (ACS). The study included 7,192 patients with ACS with no previous history of heart failure. Patients were divided into quartiles according to serum albumin levels (Q1: ≤3.50 g/dl; Q2: 3.51 to 3.80 g/dl; Q3: 3.81 to 4.08 g/dl; and Q4: >4.08 g/dl). Logistic regressions were used to explore the relations among serum albumin quartiles, new-onset heart failure, and in-hospital mortality. Serum albumin levels were negatively correlated with both high-sensitivity C-reactive protein and white blood cell count at admission. The unadjusted rate for both new-onset heart failure (37.7%, 20.2%, 14.7%, and 11.4% for Q1, Q2, Q3, and Q4, respectively; p <0.0001) and in-hospital mortality (9.8%, 3.4%, 2.0%, and 1.7% for Q1, Q2, Q3, and Q4, respectively; p <0.0001) were higher at lower serum albumin levels. Multivariate analysis demonstrated that serum albumin level ≤3.50 g/dl is an important and independent predictor of both the development of new-onset heart failure (odds ratio 2.31, 95% CI 1.87 to 2.84, p <0.0001) and in-hospital mortality (odds ratio 1.88, 95% CI 1.23 to 2.86, p = 0.003). In conclusion, albumin level ≤3.50 g/dl is an independent predictor of new-onset heart failure and in-hospital mortality in patients with ACS. The inflammatory state may be a mechanism underlying hypoalbuminemia in this clinical setting.
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Lekan DA, Wallace DC, McCoy TP, Hu J, Silva SG, Whitson HE. Frailty Assessment in Hospitalized Older Adults Using the Electronic Health Record. Biol Res Nurs 2017; 19:213-228. [PMID: 27913742 DOI: 10.1177/1099800416679730] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Frailty, a clinical syndrome of decreased physiologic reserve and dysregulation in multiple physiologic systems, is associated with increased risk for adverse outcomes. PURPOSE The aim of this retrospective, cross-sectional, correlational study was to characterize frailty in older adults admitted to a tertiary-care hospital using a biopsychosocial frailty assessment and to determine associations between frailty and time to in-hospital mortality and 30-day rehospitalization. METHODS The sample included 278 patients ≥55 years old admitted to medicine units. Frailty was determined using clinical data from the electronic health record (EHR) for symptoms, syndromes, and conditions and laboratory data for four serum biomarkers. A frailty risk score (FRS) was created from 16 risk factors, and relationships between the FRS and outcomes were examined. RESULTS The mean age of the sample was 70.2 years and mean FRS was 9.4 ( SD, 2.2). Increased FRS was significantly associated with increased risk of death (hazard ratio = 1.77-2.27 for 3 days ≤ length of stay (LOS) ≤7 days), but depended upon LOS ( p < .001). Frailty was marginally associated with rehospitalization for those who did not die in hospital (adjusted odds ratio = 1.18, p = .086, area under the curve [AUC] = 0.66, 95% confidence interval for AUC = [0.57, 0.76]). DISCUSSION Clinical data in the EHR can be used for frailty assessment. Informatics may facilitate data aggregation and decision support. Because frailty is potentially preventable and treatable, early detection is crucial to delivery of tailored interventions and optimal patient outcomes.
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Affiliation(s)
- Deborah A Lekan
- 1 School of Nursing, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Debra C Wallace
- 1 School of Nursing, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Thomas P McCoy
- 1 School of Nursing, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Jie Hu
- 2 College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Susan G Silva
- 3 School of Nursing, Duke University, Durham, NC, USA
| | - Heather E Whitson
- 4 Departments of Medicine and Opthalmology, School of Medicine, Duke University, Durham, NC, USA.,5 Durham VA Geriatrics Research Education and Clinical Center (GRECC), Durham, NC, USA
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Ancion A, Allepaerts S, Oury C, Gori AS, Piérard LA, Lancellotti P. Serum albumin level and hospital mortality in acute non-ischemic heart failure. ESC Heart Fail 2017; 4:138-145. [PMID: 28451450 PMCID: PMC5396050 DOI: 10.1002/ehf2.12128] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 09/22/2016] [Accepted: 11/09/2016] [Indexed: 12/14/2022] Open
Abstract
Aims Hypoalbuminemia is common in heart failure (HF), especially in elderly patients. It is associated with an increased risk of death. The present study sought to examine the prognostic significance of serum albumin level in the prediction of hospital mortality in patients admitted for acute non‐ischemic HF. Methods and results We examined the association between albumin and hospital mortality in a cohort of 546 patients admitted for acute non‐ischemic HF. None of the patients had infectious disease, severe arrhythmias (atrial fibrillation, ventricular tachycardia, ventricular fibrillation), required invasive ventilation, or presented with acute coronary syndrome or primary valvular disease. Thirty‐six patients (7%) died during the hospital stay. These patients were significantly older (78 ± 9 vs. 72 ± 12 years; P = 0.006), had higher heart rate (P < 0.0001), increased creatinine level (P = 0.01), lower systolic and diastolic blood pressures (P < 0.05), elevated leucocyte count (P = 0.001), and lower albumin levels (31.3 ± 5.6 g/L vs. 36.9 ± 4.1 g/L; P < 0.001). With multivariable analysis, age (P = 0.01), heart rate (P < 0.0003), diastolic blood pressure (P < 0.01), leukocyte count (P = 0.009), and serum albumin level (P < 0.0001) emerged as independent predictors of hospital mortality. Hypoalbuminemia (<34 g/L) yielded the best sensitivity (78.8%) and specificity (75%) for predicting hospital death. Conclusions Serum albumin level measured at admission can serve as a simple prognostic factor in acute non‐ischemic HF. Hypoalbuminemia is associated with increased risk of hospital mortality, especially in elderly patients.
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Affiliation(s)
- Arnaud Ancion
- University of Liège HospitalGIGA Cardiovascular Sciences, Acute Care Unit, Heart Failure Clinic, CHU Sart TilmanLiègeBelgium
| | - Sophie Allepaerts
- University of Liège HospitalGeriatric Medicine, CHU Sart TilmanLiègeBelgium
| | - Cécile Oury
- University of Liège HospitalGIGA Cardiovascular Sciences, Acute Care Unit, Heart Failure Clinic, CHU Sart TilmanLiègeBelgium
| | - Anne-Stephan Gori
- University of Liège HospitalGIGA Cardiovascular Sciences, Acute Care Unit, Heart Failure Clinic, CHU Sart TilmanLiègeBelgium
| | - Luc A Piérard
- University of Liège HospitalGIGA Cardiovascular Sciences, Acute Care Unit, Heart Failure Clinic, CHU Sart TilmanLiègeBelgium
| | - Patrizio Lancellotti
- University of Liège HospitalGIGA Cardiovascular Sciences, Acute Care Unit, Heart Failure Clinic, CHU Sart TilmanLiègeBelgium.,Gruppo Villa Maria Care and ResearchAnthea HospitalBariItaly
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Liu X, Su X, Zeng H. Impact of admission serum total cholesterol level on in-hospital mortality in patients with acute aortic dissection. Pak J Med Sci 2016; 32:939-43. [PMID: 27648044 PMCID: PMC5017107 DOI: 10.12669/pjms.324.10124] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To find out the association between serum total cholesterol (TC) on admission and in-hospital mortality in patients with acute aortic dissection (AAD). METHODS From January 2007 to January 2014, we enrolled 1492 consecutive AAD patients with serum TC measured immediately on admission. Baseline characteristics and in-hospital mortality were compared between the patients with serum TC above and below the median (4.00 mmol/L). Propensity score matching (PSM) was used to account for known confounders in the study. Cox proportional hazard model was performed to calculate the hazard ratio (HR) and 95% confidence interval (CI) for admission serum TC levels. RESULTS With the use of PSM, 521 matched pairs of patients with AAD were yielded in this analysis due to their similar propensity scores. Patients with admission serum TC < 4.00 mmol/L, as compared with those with admission serum TC ≥ 4.00 mmol/L, had higher in-hospital mortality (11.7% vs. 5.8%; HR, 2.06; 95% CI, 1.33-3.19, P = 0.001). Stratified analysis according to Stanford classification showed that the inverse association between admission serum TC and in-hospital mortality was observed in patients with Type-A AAD (24.0% vs. 11.3%; HR, 2.18; 95% CI, 1.33 - 3.57, P = 0.002) but not in those with Type-B AAD (3.8% vs. 2.2%; HR, 1.71; 95% CI, 0.67 - 4.34, P = 0.261). CONCLUSIONS Lower serum TC level on admission was strongly associated with higher in-hospital mortality in patients with Type-A AAD.
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Affiliation(s)
- Xintian Liu
- Xintian Liu, Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xi Su
- Xi Su, Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China
| | - Hesong Zeng
- Hesong Zeng, Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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High-density lipoprotein cholesterol and in-hospital mortality in patients with acute aortic dissection. ACTA ACUST UNITED AC 2016; 36:364-367. [PMID: 27376804 DOI: 10.1007/s11596-016-1592-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 04/27/2016] [Indexed: 10/21/2022]
Abstract
The association between high-density lipoprotein cholesterol (HDL-C) and mortality in patients with acute aortic dissection (AAD) is unclear. From January 2007 to January 2014, a total of 928 consecutive AAD patients who were admitted within 48 h after the onset of symptoms were enrolled in the study. Patients were divided into two groups according to whether serum HDL-C level was below the normal lower limit or not. The Cox proportional hazard regression model was used to identify the predictive value of HDL-C for in-hospital mortality in patients with AAD. As compared with normal HDL-C group (n=585), low HDL-C group (n=343) had lower levels of systolic blood pressure and hemoglobin and higher levels of leukocyte, alanine aminotransferase, blood glucose, blood urea nitrogen, creatinine and urea acid. Low HDL-C group had significantly higher in-hospital mortality than normal HDL-C group (21.6% vs. 12.6%, log-rank=10.869, P=0.001). After adjustment for baseline variables including demographics and biologic data, the increased risk of in-hospital mortality in low HDL-C group was substantially attenuated and showed no significant difference (adjusted hazard ratio, 1.23; 95% confidence interval, 0.86-1.77; P=0.259). Low HDL-C is strongly but not independently associated with in-hospital mortality in patients with AAD.
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Nakayama H, Koyama S, Kuragaichi T, Shiba M, Fujiwara H, Takatsu Y, Sato Y. Prognostic Value of Rising Serum Albumin During Hospitalization in Patients With Acute Heart Failure. Am J Cardiol 2016; 117:1305-9. [PMID: 27020611 DOI: 10.1016/j.amjcard.2016.01.030] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Revised: 01/22/2016] [Accepted: 01/22/2016] [Indexed: 01/22/2023]
Abstract
Hypoalbuminemia is an important predictor of a poor long-term prognosis in acute heart failure (AHF). However, changes in serum albumin levels in AHF have not been described to date. Therefore, we investigated the changes in serum albumin levels in patients hospitalized for AHF. This observational study included 115 consecutive patients admitted with AHF. Serum albumin was measured on days 1, 2, 4, and 7 of their hospitalization, and the changes in its levels were assessed. Cox multivariate analysis was used to compare the long-term mortality and readmission rate between 2 groups defined according to whether their serum albumin changes showed a rising pattern (serum albumin level increased from day 2 to day 7) or not. The mean serum albumin levels were 3.51 mg/dl on day 1, 3.21 mg/dl on day 2, 3.23 mg/dl on day 4, and 3.35 mg/dl on day 7 (p <0.001 by multivariate analysis of variance). The rising pattern group including 66 patients (60.6%) was independently associated with a lower mortality and readmission rate (hazard ratios 0.450 and 0.522; p = 0.01 and 0.02, respectively). Furthermore, based on multiple linear regression analysis, the changes in hemoglobin and C-reactive protein levels during days 1 to 7 were independently correlated with the changes in serum albumin levels over the same period. In conclusion, a rising pattern of serum albumin change in a patient with AHF was correlated with a good long-term prognosis. Furthermore, the change in serum albumin levels was also associated with changes in cachectic factors.
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Grodin JL, Lala A, Stevens SR, DeVore AD, Cooper LB, AbouEzzeddine OF, Mentz RJ, Groarke JD, Joyce E, Rosenthal JL, Vader JM, Tang WHW. Clinical Implications of Serum Albumin Levels in Acute Heart Failure: Insights From DOSE-AHF and ROSE-AHF. J Card Fail 2016; 22:884-890. [PMID: 26844764 DOI: 10.1016/j.cardfail.2016.01.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 01/19/2016] [Accepted: 01/28/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Hypoalbuminemia is common in patients with chronic heart failure and, as a marker of disease severity, is associated with an adverse prognosis. Whether hypoalbuminemia contributes to (or is associated with) worse outcomes in acute heart failure (AHF) is unclear. We sought to determine the implications of low serum albumin in patients receiving decongestive therapies for AHF. METHODS AND RESULTS Baseline serum albumin levels were measured in 456 AHF subjects randomized in the DOSE-AHF and ROSE-AHF trials. We assessed the relationship between admission albumin levels (both as a continuous variable and stratified by median albumin [≥3.5 g/dL]) and worsening renal function (WRF), worsening heart failure (WHF), and clinical decongestion by 72 hours; 7-day cardiorenal biomarkers; and post-discharge outcomes. The mean baseline albumin level was 3.5 ± 0.5 g/dL. Albumin was not associated with WRF, WHF, or clinical decongestion by 72 hours. Furthermore, there was no association between continuous albumin levels and symptom change according to visual analog scale or weight change by 72 hours. Albumin was not associated with 60-day mortality, rehospitalization, or unscheduled emergency room visits. CONCLUSIONS Baseline serum albumin levels were not associated with short-term clinical outcomes for AHF patients undergoing decongestive therapies. These data suggest that serum albumin may not be a helpful tool to guide decongestion strategies.
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Affiliation(s)
- Justin L Grodin
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Anuradha Lala
- Department of Advanced Heart Disease, Brigham and Women's Hospital, Boston, Massachusetts; Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Medical Center, New York, New York
| | - Susanna R Stevens
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Adam D DeVore
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina; Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Lauren B Cooper
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina; Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Omar F AbouEzzeddine
- Department of Medicine, Division of Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Robert J Mentz
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina; Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - John D Groarke
- Department of Advanced Heart Disease, Brigham and Women's Hospital, Boston, Massachusetts
| | - Emer Joyce
- Department of Advanced Heart Disease, Brigham and Women's Hospital, Boston, Massachusetts
| | - Julie L Rosenthal
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Justin M Vader
- Department of Medicine, Division of Cardiology, Washington University School of Medicine, St Louis, Missouri
| | - W H Wilson Tang
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
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Hirotomi T, Yoshihara A, Ogawa H, Miyazaki H. Number of teeth and 5-year mortality in an elderly population. Community Dent Oral Epidemiol 2015; 43:226-31. [PMID: 25600364 DOI: 10.1111/cdoe.12146] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 12/18/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Several epidemiological studies have shown the association between tooth loss and mortality. However, the impact of number of teeth on mortality has not yet been fully addressed in an elderly population with many teeth. Thus, the purpose of this cohort study was to assess the possible role of number of teeth as a predictor of mortality in the elderly. METHODS The subjects included in this study were generated from a cohort study started in 1998. Oral examinations and the completion of a questionnaire were carried out. A total of 600 subjects aged 70 years were enrolled at baseline. All the subjects were in good general health and did not require any special care for their daily activities. The 5-year mortality data were collected after the baseline survey. After excluding those with incomplete data, 569 subjects were analyzed. The Kaplan-Meier method was used to analyze survival curves and a Cox regression model to clarify the impact of the number of remaining teeth on the 5-year mortality. RESULTS During the follow-up period, 25 (4.4%) subjects died. Subjects with 20 teeth or more had a significantly lower mortality rate (2.5%) than those with 19 teeth or fewer (6.1%, log-rank test, P = 0.036). Even after adjusting for confounders including gender, BMI, serum albumin level, current smoking status, education, number of family members living together and a history of chronic diseases, the risk of all-cause mortality was significantly associated with the number of remaining teeth (P = 0.047) with a hazard ratio of 0.96, indicating that there was a 4% point increase in the 5-year survival rate per additional tooth retained at the age of 70. CONCLUSION The findings of this study suggest that retaining more teeth might be a useful indicator for longevity of older people.
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Affiliation(s)
- Toshinobu Hirotomi
- Division of Preventive Dentistry, Department of Oral Health Science, Graduate School of Medical and Dental Sciences, Niigata University, Japan
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Jabbour R, Ling HZ, Norrington K, Amaral N, Zaman N, Aggarwal S, Aung N, Barron A, Manisty C, Baruah R, Cole GD, Missouris CG, Mayet J, Francis DP, Cheng AS, Thomas M, Woldman S, Okonko DO. Serum albumin changes and multivariate dynamic risk modelling in chronic heart failure. Int J Cardiol 2014; 176:437-43. [PMID: 25129278 DOI: 10.1016/j.ijcard.2014.07.096] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 07/23/2014] [Accepted: 07/26/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND We examined the prognostic utility of rate of change in serum albumin over time in chronic heart failure (CHF), as well as the utility of multivariate dynamic risk modelling. METHODS AND RESULTS The survival implication of ∆albumin was analysed in 232 systolic CHF patients and validated in 212 patients. A multivariate dynamic risk score predicated on the rate of change in 6 simple indices including albumin was calculated and related to mortality. In derivation patients, 50 (22%) deaths occurred over 13 months. Greater rates of decline in albumin related to higher mortality (HR 0.55, 95% CI 0.41-0.73, P<0.0001) independently, incrementally and more accurately than other covariates including baseline albumin. A rate of attenuation >0.4 g/dL/month optimally forecasted death and was associated with a 5-fold escalated risk of mortality (HR 5.13, 95% CI 2.92-9.00, P<0.0001). Similar results were seen in the validation cohort. On multivariate dynamic risk modelling, survival at 1-year worsened with higher scores-a score ≥ 3 was associated with a 12-fold greater risk of death than a score of 0, a 6-fold higher risk of death than a score of 1, and a 4-fold enhanced risk of mortality than a score of 2. CONCLUSION Attenuations in serum albumin over time relate to increased mortality in CHF, and a risk model predicated on the rate of change in 6 simple indices can identify patients at a 12-fold enhanced risk of death over the coming year.
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Affiliation(s)
- Richard Jabbour
- International Centre for Circulatory Health, NHLI, Imperial College, London, UK
| | | | - Karl Norrington
- International Centre for Circulatory Health, NHLI, Imperial College, London, UK
| | - Nelson Amaral
- International Centre for Circulatory Health, NHLI, Imperial College, London, UK
| | - Nabeela Zaman
- International Centre for Circulatory Health, NHLI, Imperial College, London, UK
| | - Suneil Aggarwal
- University College London Hospital, London, UK; The Heart Hospital, London, UK
| | - Nay Aung
- University College London Hospital, London, UK
| | - Anthony Barron
- International Centre for Circulatory Health, NHLI, Imperial College, London, UK
| | - Charlotte Manisty
- International Centre for Circulatory Health, NHLI, Imperial College, London, UK
| | | | - Graham D Cole
- International Centre for Circulatory Health, NHLI, Imperial College, London, UK
| | | | - Jamil Mayet
- International Centre for Circulatory Health, NHLI, Imperial College, London, UK
| | - Darrel P Francis
- International Centre for Circulatory Health, NHLI, Imperial College, London, UK
| | | | - Martin Thomas
- University College London Hospital, London, UK; The Heart Hospital, London, UK
| | - Simon Woldman
- University College London Hospital, London, UK; The Heart Hospital, London, UK
| | - Darlington O Okonko
- International Centre for Circulatory Health, NHLI, Imperial College, London, UK; University College London Hospital, London, UK; The Heart Hospital, London, UK.
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Castleberry C, White-Williams C, Naftel D, Tresler MA, Pruitt E, Miyamoto SD, Murphy D, Spicer R, Bannister L, Schowengerdt K, Gilmore L, Kaufman B, Zangwill S. Hypoalbuminemia and poor growth predict worse outcomes in pediatric heart transplant recipients. Pediatr Transplant 2014; 18:280-7. [PMID: 24646199 DOI: 10.1111/petr.12239] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2014] [Indexed: 11/28/2022]
Abstract
Children with end-stage cardiac failure are at risk of HA and PG. The effects of these factors on post-transplant outcome are not well defined. Using the PHTS database, albumin and growth data from pediatric heart transplant patients from 12/1999 to 12/2009 were analyzed for effect on mortality. Covariables were examined to determine whether HA and PG were risk factors for mortality at listing and transplant. HA patients had higher waitlist mortality (15.81% vs. 10.59%, p = 0.015) with an OR of 1.59 (95% CI 1.09-2.30). Survival was worse for patients with HA at listing and transplant (p ≤ 0.01 and p = 0.026). Infants and patients with congenital heart disease did worse if they were HA at time of transplant (p = 0.020 and p = 0.028). Growth was poor while waiting with PG as risk factor for mortality in multivariate analysis (p = 0.008). HA and PG are risk factors for mortality. Survival was worse in infants and patients with congenital heart disease. PG was a risk factor for mortality in multivariate analysis. These results suggest that an opportunity may exist to improve outcomes for these patients by employing strategies to mitigate these risk factors.
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Uchikawa T, Shimano M, Inden Y, Murohara T. Serum albumin levels predict clinical outcomes in chronic kidney disease (CKD) patients undergoing cardiac resynchronization therapy. Intern Med 2014; 53:555-61. [PMID: 24633024 DOI: 10.2169/internalmedicine.53.1209] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE A low level of serum albumin is common in chronic kidney disease (CKD) patients with heart failure (HF). Cardiac resynchronization therapy (CRT), a novel therapeutic option, improves cardiac performance in patients with severe HF. In addition, CKD has recently been found to be associated with outcomes after CRT; however, the associations of the serum albumin levels with adverse events and the long-term prognosis in CKD patients who have undergone CRT are unknown. In this study, we investigated whether the albumin levels can be used to the predict mortality rate and incidence of cardiovascular events in CKD patients treated with CRT. METHODS A retrospective chart review was conducted in 102 consecutive CKD patients receiving a CRT device for the treatment of advanced HF. The long-term outcomes following device implantation were assessed according to the albumin levels. RESULTS During a median follow-up of 2.6 years, 34 patients (33.3%) died and 66 patients (64.7%) experienced cardiovascular events. A Kaplan-Meier survival analysis revealed that the CKD patients with decreased albumin levels exhibited significantly higher rates of all-cause mortality and cardiovascular events, including hospitalization for progressive HF, than the CKD patients without hypoalbuminemia. Importantly, a multivariate Cox regression analysis of confounding factors showed a low serum albumin level to independently predict all-cause death and cardiovascular events. CONCLUSION Hypoalbuminemia independently predicts cardiac morbidity and mortality in CKD patients receiving CRT. Assessing the albumin levels provides valuable information regarding the long-term prognosis in CKD patients who undergo CRT.
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Affiliation(s)
- Tomohiro Uchikawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Japan
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Cleland JG, Chiswell K, Teerlink JR, Stevens S, Fiuzat M, Givertz MM, Davison BA, Mansoor GA, Ponikowski P, Voors AA, Cotter G, Metra M, Massie BM, O'Connor CM. Predictors of postdischarge outcomes from information acquired shortly after admission for acute heart failure: a report from the Placebo-Controlled Randomized Study of the Selective A1 Adenosine Receptor Antagonist Rolofylline for Patients Hospitalized With Acute Decompensated Heart Failure and Volume Overload to Assess Treatment Effect on Congestion and Renal Function (PROTECT) Study. Circ Heart Fail 2013; 7:76-87. [PMID: 24281134 DOI: 10.1161/circheartfailure.113.000284] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acute heart failure is a common reason for admission, and outcome is often poor. Improved prognostic risk stratification may assist in the design of future trials and in patient management. Using data from a large randomized trial, we explored the prognostic value of clinical variables, measured at hospital admission for acute heart failure, to determine whether a few selected variables were inferior to an extended data set. METHODS AND RESULTS The prognostic model included 37 clinical characteristics collected at baseline in PROTECT, a study comparing rolofylline and placebo in 2033 patients admitted with acute heart failure. Prespecified outcomes at 30 days were death or rehospitalization for any reason; death or rehospitalization for cardiovascular or renal reasons; and, at both 30 and 180 days, all-cause mortality. No variable had a c-index>0.70, and few had values>0.60; c-indices were lower for composite outcomes than for mortality. Blood urea was generally the strongest single predictor. Eighteen variables contributed independent prognostic information, but a reduced model using only 8 items (age, previous heart failure hospitalization, peripheral edema, systolic blood pressure, serum sodium, urea, creatinine, and albumin) performed similarly. For prediction of all-cause mortality at 180 days, the model c-index using all variables was 0.72 and for the simplified model, also 0.72. CONCLUSIONS A few simple clinical variables measured on admission in patients with acute heart failure predict a variety of adverse outcomes with accuracy similar to more complex models. However, predictive models were of only moderate accuracy, especially for outcomes that included nonfatal events. Better methods of risk stratification are required. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00328692 and NCT00354458.
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Affiliation(s)
- John G Cleland
- University of Hull, Kingston upon Hull, and National Heart and Lung Institute, Imperial College, London, United Kingdom
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Cardiohepatic Interactions in Heart Failure. J Am Coll Cardiol 2013; 61:2397-2405. [DOI: 10.1016/j.jacc.2013.03.042] [Citation(s) in RCA: 174] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 03/01/2013] [Accepted: 03/03/2013] [Indexed: 01/07/2023]
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Greene SJ, Vaduganathan M, Lupi L, Ambrosy AP, Mentz RJ, Konstam MA, Nodari S, Subacius HP, Fonarow GC, Bonow RO, Gheorghiade M. Prognostic significance of serum total cholesterol and triglyceride levels in patients hospitalized for heart failure with reduced ejection fraction (from the EVEREST Trial). Am J Cardiol 2013. [PMID: 23206923 DOI: 10.1016/j.amjcard.2012.10.042] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Lower cholesterol levels are associated with worse outcomes in patients with chronic heart failure (HF) and have been shown to predict in-hospital mortality. The relation between lipid profile and postdischarge outcomes in patients hospitalized for worsening HF is less clear. In this post hoc analysis of the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvaptan (EVEREST), 3,957 patients hospitalized for worsening HF with ejection fractions ≤40% were examined. Baseline total cholesterol and triglyceride levels were measured <48 hours after admission and evaluated as continuous variables. The primary end points of all-cause mortality and cardiovascular mortality or hospitalization for HF were compared using Cox regression models. Patient characteristics at randomization were also compared among quartiles of total cholesterol. Patients with lower total cholesterol tended to have lower blood pressure, ejection fractions, serum sodium, and albumin, and were more likely to have worse HF functional class, to have higher natriuretic peptide levels, and to have histories of diabetes mellitus, renal insufficiency, and coronary revascularization (all p values <0.001). After adjustment for baseline clinical risk factors, total cholesterol was predictive of all-cause mortality (hazard ratio 0.73, 95% confidence interval 0.63 to 0.85, p <0.001) and cardiovascular mortality or hospitalization for HF (hazard ratio 0.73, 95% confidence interval 0.66 to 0.82, p <0.001) at median follow-up of 9.9 months. Lower baseline triglyceride level was also associated with worse outcomes. In conclusion, lower baseline total cholesterol is correlated with a high-risk patient profile and is a marker of disease severity in patients hospitalized for worsening HF with reduced ejection fraction. Baseline total cholesterol and triglyceride levels are predictive of mortality and HF rehospitalization beyond traditional risk factors.
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Affiliation(s)
- Stephen J Greene
- Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Manu P, Asif M, Khan S, Ashraf H, Mani A, Guvenek-Cokol P, Lee H, Kane JM, Correll CU. Risk factors for medical deterioration of psychiatric inpatients: opportunities for early recognition and prevention. Compr Psychiatry 2012; 53:968-74. [PMID: 22520089 DOI: 10.1016/j.comppsych.2012.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 02/29/2012] [Accepted: 03/12/2012] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Medical deterioration during admission to free-standing psychiatric hospitals is distressing for patients, interrupts bio-behavioral interventions, and places a substantial burden on health care resources. Emergency transfers to a general hospital are a reasonable marker of significant medical deterioration, but have not been assessed systematically. OBJECTIVE To use clinical data available at the time of psychiatric admission to identify risk factors for transfers to a general hospital. METHOD Retrospective review of the hospital course of 1000 adults consecutively admitted for an average of 19.1 ± 21.3 days to a single free-standing psychiatric hospital in 2010. RESULTS One hundred forty-four patients (14.4%) were transferred to a general hospital. Transferred and not-transferred groups differed significantly with regard to age, presence of dementia, number of comorbid medical disorder, history of arterial hypertension, blood urea nitrogen (BUN), creatinine, albumin, glucose, calcium, hemoglobin, and hematocrit (P < .001). In a multiple logistic regression analysis, blood urea nitrogen (odds ratio [OR], 63.2), hemoglobin (OR, 35.3), albumin (OR, 7.3) and age (OR, 5.73) were independently associated with transfers. Acute medical deteriorations occurred in 46.2% of patients with azotemia (BUN >24 mg/dL), 32.7% of those with anemia (Hb <12 g/L), 37.5 % of those with hypoalbuminemia (albumin <3.7 g/dL), and 37.4% of patients 65 and older. CONCLUSION Medical deterioration of psychiatric inpatients correlates with higher BUN, lower albumin and hemoglobin, and older age. Baseline azotemia, anemia or hypoalbuminemia should trigger prompt medical evaluation and enhanced monitoring to prevent, identify, and treat somatic disorders.
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Affiliation(s)
- Peter Manu
- Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, New York 11004, USA.
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Ambrosy AP, Vaduganathan M, Huffman MD, Khan S, Kwasny MJ, Fought AJ, Maggioni AP, Swedberg K, Konstam MA, Zannad F, Gheorghiade M. Clinical course and predictive value of liver function tests in patients hospitalized for worsening heart failure with reduced ejection fraction: an analysis of the EVEREST trial. Eur J Heart Fail 2012; 14:302-11. [PMID: 22357577 DOI: 10.1093/eurjhf/hfs007] [Citation(s) in RCA: 145] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
AIMS Abnormal liver function tests (LFTs) are common in ambulatory heart failure (HF). The aim of this study was to characterize abnormal LFTs during index hospitalization. METHODS AND RESULTS A post-hoc analysis was carried out of the placebo group of the EVEREST (Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan) trial, which enrolled patients hospitalized for HF with an ejection fraction (EF) ≤40% and no history of primary significant liver disease or acute hepatic failure. LFTs (abbreviation, cut-offs for abnormal values) including serum albumin (ALB, <3.3 g/dL), aspartate transaminase (AST, >34 IU/L), alanine transaminase (ALT, >34 IU/L), alkaline phosphatase (AP, >123 IU/L),γ-glutamyl transferase (GGT, >50 IU/L), and total bilirubin (T Bili, >1.2 mg/dL) were measured at baseline, discharge/day 7, and post-discharge. Co-primary endpoints were all-cause mortality (ACM) and cardiovascular mortality or first HF hospitalization (CVM + HFH). Study participants had a mean age of 65.6 ±12.0 years, were mostly male, reported high prevalences of medical co-morbidities, and were well treated with evidence-based therapies. Baseline LFT abnormalities were common (ALB 17%, AST 21%, ALT 21%, AP 23%, GGT 62%, and T Bili 26%). Abnormal T Bili was the only marker to decrease substantially from baseline (26%) to discharge/day 7 (19%). All LFTs, except AP, improved post-discharge. Lower baseline ALB and elevated T Bili were associated with higher rates of ACM, and in-hospital decreases in ALB and increases in T Bili were associated with higher rates of both ACM and CVM + HFH. CONCLUSION LFT abnormalities are common during hospitalization for HF in patients with reduced EF and were persistent at discharge. Baseline and in-hospital changes in ALB and T Bili provide additional prognostic value.
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Affiliation(s)
- Andrew P Ambrosy
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Su W, An T, Zhou Q, Huang Y, Zhang J, Zhang Y, Wei B, Sun X, Zou C, Lou K. Serum albumin is a useful prognostic indicator and adds important information to NT-proBNP in a Chinese cohort of heart failure. Clin Biochem 2012; 45:561-5. [DOI: 10.1016/j.clinbiochem.2012.02.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 02/07/2012] [Accepted: 02/09/2012] [Indexed: 11/30/2022]
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Takata Y, Ansai T, Yoshihara A, Miyazaki H. Serum albumin (SA) levels and 10-year mortality in a community-dwelling 70-year-old population. Arch Gerontol Geriatr 2012; 54:39-43. [DOI: 10.1016/j.archger.2011.02.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 02/23/2011] [Accepted: 02/24/2011] [Indexed: 10/18/2022]
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Usefulness of serum albumin and serum total cholesterol in the prediction of hospital death in older patients with severe, acute heart failure. Arch Cardiovasc Dis 2011; 104:502-8. [DOI: 10.1016/j.acvd.2011.06.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 06/01/2011] [Accepted: 06/06/2011] [Indexed: 11/18/2022]
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Arques S, Ambrosi P. Human Serum Albumin in the Clinical Syndrome of Heart Failure. J Card Fail 2011; 17:451-8. [DOI: 10.1016/j.cardfail.2011.02.010] [Citation(s) in RCA: 137] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Revised: 02/15/2011] [Accepted: 02/24/2011] [Indexed: 11/15/2022]
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