natriuretic-peptide--brain and Hypoalbuminemia

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.. 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.. 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.. 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.

Topics: Heart Failure; Hospital Mortality; Humans; Hypoalbuminemia; Length of Stay; Natriuretic Peptide, Brain; Patient Readmission; Prognosis; Risk Factors; Serum Albumin

Cardiopulmonary bypass usage provokes a systemic inflammatory response resulting in deterioration of renal function. However, risk factors for requiring renal replacement therapy (RRT) following off-pump coronary artery bypass graft surgery (CABG) have not yet been fully elucidated. We reviewed 718 consecutive patients undergoing elective off-pump CABG at our institution, excluding patients on chronic hemodialysis preoperatively. Sub-analysis of patients with preserved renal function, defined as a creatinine level below a cut-off value of 1.12 mg/dL (obtained by receiver operating characteristic curve), was also performed. Of the 718 patients, 41 (5.7 %) required RRT. There were 556 patients (77.4 %) with preserved renal function preoperatively, and 13 (2.4 %) of these required postoperative RRT. Multivariate analysis revealed that age (years) and preoperative serum creatinine (mg/dL) and brain natriuretic peptide (BNP) levels (pg/dL) were associated with RRT [odds ratios (OR) 1.052, 95 % confidence interval (CI) 9.064 and 1.001, respectively, all p < 0.05] in the total population, whereas low albumin concentration was the only independent predictor for RRT in patients with preserved renal function (OR 0.062, p < 0.0001). When creatinine levels were below 1.5 mg/dL, the predictive power of hypoalbuminemia for RRT requirement overwhelmed that of creatinine or BNP levels. Older age, preoperative elevated creatinine and BNP levels were associated with a requirement for RRT following off-pump CABG. In patients with preserved renal function, hypoalbuminemia was most significantly related to the RRT requirement.

Topics: Aged; Aged, 80 and over; Coronary Artery Bypass, Off-Pump; Creatinine; Female; Humans; Hypoalbuminemia; Japan; Kidney Function Tests; Male; Middle Aged; Multivariate Analysis; Natriuretic Peptide, Brain; Postoperative Complications; Renal Insufficiency; Renal Replacement Therapy; Risk Factors; ROC Curve

To analyze the prognostic value of serum albumin for in-hospital mortality in patients with heart failure.. A total of 2 430 consecutive heart failure patients aged at (68±14) years were enrolled in the study. Patients were divided into 2 groups according to serum albumin concentration on admission: the normoalbuminemia group (≥35 g/L) and the hypoalbuminemia group (<35 g/L). Propensity score matching was conducted to reduce confounding bias between the groups. Cox proportional-hazards regression models were used to evaluate the prognostic value of serum albumin for in-hospital mortality in patients with heart failure before and after matching.. Compared with those in the normoalbuminemia group, subjects in the hypoalbuminemia group were older, and had higher NYHA functional status and higher in-hospital mortality. More patients were diagnosed with dilated cardiomyopathy and valvular heart disease, and fewer were with hypertension in the hypoalbuminemia group than those patients in the normoalbuminemia group. Moreover, patients in this group presented with faster heart rate and lower systolic blood pressure than those in the normoalbuminemia group. They had higher levels of direct bilirubin, alkaline phosphatase, glutamyltranspetidase, creatinine, uric acid, urea, and B-type natriuretic peptide (BNP) and lower levels of hemoglobin, total cholesterol (TC), and serum sodium compared with subjects in the normoalbuminemia group. Left ventricular ejection fractions (LVEF) of patients were lower in the hypoalbuminemia group than those of patients in the normoalbuminemia group. More patients were of long-duration and treated with spirolactone. With protensity score matching, 631 pairs of patients were successfully matched. Before matching, the in-hospital mortality in normoalbuminemia group was 1.2% and that in hypoalbuminemia group was 5.7%. The multivariate Cox regression analysis indicated that the risk for in-hospital death in patients with heart failure was 12.0% greater for each 1 g/L decrement in albumin level after adjusted for all clinical factors (HR 1.120, 95% CI 1.057-1.186; P<0.001). The same held after matching. The in-hospital mortality in normoalbuminemia group was 2.9%, and that in hypoalbuminemia group was 5.7%. The multivariate Cox regression analysis showed that the risk for in-hospital death in patients with heart failure was 11.0% greater for each 1 g/L decrement in albumin level after adjusted for all clinical factors (HR 1.110, 95% CI 1.043-1.181; P=0.001).. Serum albuminis is an independent risk factor for in-hospital mortality in patients with heart failure. Treatment of hypoalbuminemia may lower the in-hospital mortality in patients with heart failure.

Topics: Aged; Aged, 80 and over; Cholesterol; Creatinine; Heart Failure; Hospital Mortality; Humans; Hypoalbuminemia; Middle Aged; Natriuretic Peptide, Brain; Predictive Value of Tests; Prognosis; Propensity Score; Regression Analysis; Risk Factors; Serum Albumin; Ventricular Function, Left

Hypotension during hemodialysis (HD) is an important problem in patients on HD. To investigate the risk factors that contribute to the hypotension during HD, we compared background factors of hypotensive (HP) patients during HD. Among 58 patients undergoing HD in Tamura Memorial Hospital, 12 patients could not continue full HD because of hypotension. We compared the data of ultrafiltration volume, cardiothoracic ratio (CTR), total protein (TP), serum albumin, blood urea nitrogen (BUN), serum creatinine, total cholesterol (TC), hemoglobin (Hb), blood glucose (BS), brain natriuretic peptide (BNP), and cardiac function between HP patients (HP group; n=12) and sex- and age-matched control patients (NP group; n=12). There were no significant differences of age, sex, and duration of HD between the 2 groups. Cardiothoracic ratio is bigger and BNP is higher in the HP group compared with the NP group (CTR: HP 55.8+/-2.9% vs. NP 47.7+/-1.1%, p=0.0165; BNP: HP 602+/-171 vs. NP 147+/-38, p=0.0167). Serum albumin in the HP group is significantly lower compared with the NP group (HP 3.2+/-0.1 g/dL vs. NP 3.5+/-0.1 g/dL, p=0.0130). However, there were no significant differences of ultrafiltration rate (UFR), BS, TC, Hb, and cardiac function between the 2 groups. There is a significant negative correlation between changes of systolic blood pressure (delta systolic blood pressure) and serum albumin in these patients (r=-0.598, p=0.0016). From these data, we conclude that hypoalbuminemia is a major risk factor of hypotension during HD.

Topics: Aged; Biomarkers; Blood Pressure; Blood Urea Nitrogen; Cholesterol; Creatinine; Echocardiography; Female; Follow-Up Studies; Heart Ventricles; Humans; Hypoalbuminemia; Hypotension; Kidney Failure, Chronic; Male; Natriuretic Peptide, Brain; Prognosis; Renal Dialysis; Retrospective Studies; Risk Factors; Serum Albumin; Ventricular Function, Left