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Author Spotlight: Unveiling Prognostic Indicators in Heart Failure - The Role of Phase Angle and Bioelectrical Impedance Analysis
Published on: June 30, 2023
Prognostic value of albumin-based indices for mortality after heart failure: a systematic review and meta-analysis
Ji Jiang1, Ping Miao2, Gang Xin3
1Emergency department, the Affiliated People's Hospital of Ningbo University, 251 Baizhang East Road, Ningbo, Zhejiang Province, China. newgo123456@163.com.
Insights
Albumin-based indices like the albumin-bilirubin score (ABS) predict heart failure mortality. Other ratios also show predictive value, though data is limited.
Area of Science:
- Cardiology
- Biomarkers
- Prognostics
Background:
- Albumin-based indices are explored for predicting heart failure (HF) mortality.
- This study investigates the predictive utility of several albumin ratios and the albumin-bilirubin score (ABS).
Purpose of the Study:
- To evaluate the effectiveness of albumin-based indices in predicting mortality in heart failure patients.
- To assess the prognostic value of albumin-globin ratio, lactate-albumin ratio, BUN-albumin ratio, fibrinogen-albumin ratio, and ABS.
Main Methods:
- A systematic literature search was conducted across major databases (Embase, PubMed, Web of Science, Scopus).
- A random-effect meta-analysis of multivariate adjusted data was performed to calculate pooled hazard ratios (HR) and 95% confidence intervals (CI).
- Subgroup analyses were performed for short-term (<90 days) and long-term (≥1 year) mortality.
Main Results:
- Meta-analysis included seven studies on ABS, three on BUN-albumin, three on fibrinogen-albumin, and two each on albumin-globulin and lactate-albumin ratios.
- The albumin-bilirubin score (ABS) significantly predicted both short-term (HR: 2.01) and long-term (HR: 1.36) mortality in HF.
- High fibrinogen-albumin ratio (HR: 1.12), BUN-albumin ratio (HR: 1.84), and lactate-albumin ratio (HR: 1.84) were also identified as predictors of HF mortality.
Conclusions:
- The quality of evidence for albumin-based indices predicting HF mortality is very low.
- The albumin-bilirubin score (ABS) independently predicts both short-term and long-term mortality after heart failure.
- Other albumin ratios also show potential in predicting HF mortality, but require further investigation due to limited data.
Background:
Albumin-based indices have been used to predict mortality after heart failure (HF). We hereby examined the utility of albumin-globin ratio, lactate-albumin ratio, blood urea nitrogen (BUN)-albumin ratio, fibrinogen-albumin ratio, and albumin-bilirubin score (ABS) in predicting mortality after HF.
Methods:
We searched Embase, PubMed, Web of Science, and Scopus databases up to 2nd October 2024 for studies examining association between albumin-based indices and mortality after HF. A random-effect meta-analysis was conducted using multivariate adjusted data to calculate pooled hazard ratio (HR) with 95% confidence intervals (CI). Subgroup analysis was conducted for short-term (< 90 days) and long-term mortality (≥ 1 year) where possible.
Results:
There were seven studies on ABS, three studies each on BUN-albumin and fibrinogen-albumin ratio, and two studies each for albumin-globulin and lactate-albumin ratio. Meta-analysis showed that ABS was predictive of both short-term (HR: 2.01 95% CI: 1.01, 4.00 I2 = 62% p = 0.05) and long-term (HR: 1.36 95% CI: 1.05, 1.76 I2 = 49% p = 0.02) mortality after HF. Meta-analysis also showed that high fibrinogen-albumin ratio (HR: 1.12 95% CI: 1.09, 1.14 I2 = 0% p < 0.00001), BUN-albumin ratio (HR: 1.84 95% CI: 1.28, 2.64 I2 = 64% p = 0.001), and lactate-albumin ratio (HR: 1.84 95% CI: 1.68, 2.01 I2 = 0% p < 0.00001) were predictors of mortality after HF.
Conclusion:
Very low quality of evidence indicates that albumin-based indices can predict mortality after HF. ABS was found to independently predict short and long-term mortality after HF. Other ratios like the albumin-globin ratio, lactate-albumin ratio, BUN-albumin ratio, and fibrinogen-albumin ratio were also found to predict mortality after HF albeit with limited data.
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