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Cutoff Value of Phase Angle by Bioelectrical Impedance Analysis at Admission as a Prognostic Factor in Patients with Acute Heart Failure
Published on: June 10, 2025
Low prealbumin is strongly associated with adverse outcome in heart failure
Patrícia Lourenço1, Sérgio Silva1, Fernando Friões1
1Serviço de Medicina Interna, Centro Hospitalar São João, Faculdade de Medicina da Universidade do Porto, Unidade I&D Cardiovascular do Porto, Porto, Portugal.
Insights
Low discharge prealbumin levels (≤15.0 mg/dL) in heart failure (HF) patients indicate a higher risk of 6-month mortality and hospital readmissions. This finding highlights the prognostic value of prealbumin in HF management.
Area of Science:
- Cardiology
- Clinical Nutrition
- Biochemistry
Background:
- Prealbumin is a key indicator of nutritional status.
- Previous research linked prealbumin to in-hospital mortality in heart failure (HF) patients.
- The prognostic significance of low discharge prealbumin in acute HF requires further evaluation.
Purpose of the Study:
- To assess whether low discharge prealbumin levels predict morbidity and mortality in patients admitted with acute heart failure.
- To determine the association between discharge prealbumin concentration and adverse outcomes up to 6 months post-discharge.
Main Methods:
- A prospective observational study involving 514 patients admitted with acute heart failure.
- Follow-up was conducted for up to 6 months, monitoring all-cause and HF-specific death, and all-cause and worsening HF hospitalizations.
- Cox-regression analysis was employed to evaluate the prognostic impact of discharge prealbumin levels (≤15.0 mg/dL vs. >15.0 mg/dL).
Main Results:
- Patients with discharge prealbumin ≤15.0 mg/dL exhibited higher rates of 6-month all-cause and HF-specific death (adjusted HRs 1.67 and 2.12, respectively).
- These patients also had increased risk of all-cause and HF readmission (adjusted HRs 1.47 and 1.58, respectively).
- Lower prealbumin was associated with demographic factors (female, older age) and clinical markers (lower albumin, hemoglobin, higher CRP, BNP).
Conclusions:
- A discharge prealbumin level of ≤15.0 mg/dL is a significant predictor of increased 6-month morbidity and mortality in acute heart failure patients.
- The study suggests an imbalance in protein-energy status contributes to poor outcomes in HF.
- Prealbumin serves as a valuable prognostic marker for guiding HF patient management.
Objective:
Prealbumin is one of the best indicators of nutritional status. We previously showed that prealbumin predicted in-hospital mortality in heart failure (HF) patients. We evaluated if a low discharge prealbumin after admission with acute HF would predict morbidity and mortality.
Methods:
We conducted a prospective observational study. Patients admitted with a primary diagnosis of HF were studied. Follow-up was up to 6 months. Endpoints analysed were: all-cause and HF-death; all-cause and worsening HF hospitalisation. Patients with discharge prealbumin ≤15.0 mg/dL and those with prealbumin >15 mg/dL were compared. A Cox-regression analysis was used to evaluate the prognostic impact of low prealbumin.
Results:
We studied 514 patients. Mean age was 78 years and 45.7% were male. During follow-up, 101 patients died (78 for HF) and 209 patients were hospital readmitted (140 for worsening HF). Median prealbumin was 20.1 (15.3-25.3) mg/dL. Patients with lower prealbumin were more often women, older aged and with non-ischaemic HF; they had lower albumin, haemoglobin and total cholesterol; and higher glomerular filtration rate, C-reactive protein, B-type natriuretic peptide and length of hospital stay. Lower prealbumin associated with less β-blocker and statin use. Patients with discharge prealbumin ≤15 mg/dL had a multivariate adjusted HR of 6-month all-cause and HF death of 1.67 (1.00 to 2.80) and 2.12 (1.19 to 3.79) respectively and of all-cause and HF readmission of 1.47 (1.01 to 2.14) and 1.58 (1.01 to 2.47).
Conclusions:
Patients with discharge prealbumin ≤15 mg/dL have an higher risk of 6 months morbidity and mortality. The unbalance between protein-energy demands and its availability predicts ominous HF outcome.
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