Changes in albumin-bilirubin (ALBI) score during hospitalization and post-discharge outcomes in patients with acute heart failure
T Kawata, A IkedaAbstract
Background
The albumin-bilirubin (ALBI) score has recently been proposed as a novel, clinically-applicable scoring system for liver dysfunction. Although the ALBI score has recently been reported as a prognosticator in patients with heart failure (HF), that is evaluated usually on one occasion, and any changes in ALBI score during hospitalization are not considered.
Purpose
To explore between changes in ALBI score during hospitalization and post-discharge outcomes in patients with acute HF.
Methods
We retrospectively enrolled 226 patients (median age, 84 years; 128 male) admitted to our hospital for the treatment of acute HF. Based on a previous study regarding albumin change and HF, only patients who were hospitalized for 7 days or more were eligible. The ALBI score was calculated on admission and at discharge based on the original report. According to the ALBI score change during hospitalization, patients were classified as either improved (ALBI score at discharge < ALBI score on admission) or deteriorated (ALBI score at discharge ≥ ALBI score on admission). The date of discharge was considered the entry time-point of observation. Primary outcomes were all-cause death or unplanned nonfatal HF hospitalization.
Results
Median length of hospital stay was 18 (13-24) days. During a median follow-up period of 599 (232-1186) days, 34 all-cause deaths and 66 nonfatal HF hospitalizations were occurred. In univariate Cox proportional hazards analysis, age, body mass index, systolic blood pressure, left ventricular ejection fraction, the ratio of peak early diastolic trans-mitral flow velocity to annular velocity, tricuspid regurgitation velocity, hemoglobin level, estimated glomerular filtration rate, B-type natriuretic peptide (BNP) concentration, ALBI score at discharge and the ALBI improved group were associated with outcomes. The event-free rate determined by Kaplan-Meier analysis was significantly higher in patients in the ALBI improved group (log-rank test, p < 0.0001) compared to the ALBI deteriorated group. In multivariate Cox proportional hazards analysis, higher hemoglobin level [hazard ratio (HR) 0.83, 95% confidence interval (CI) 0.72-0.96, p = 0.015], lower BNP concentration (HR 1.001, 95%CI 1.0003-1.002, p = 0.0065) and ALBI improved group (HR 0.32, 95%CI 0.18-0.54, p < 0.0001) were independently associated with favorable outcomes.
Conclusion
Changes in ALBI score during hospitalization, using the ALBI score on admission and at discharge, may be useful for risk stratification in patients with HF.