Prognostic value of prealbumin and PROFUND index in patients with acute heart failure: Results from the RICA Registry

Acute heart failure (AHF) is a leading cause of hospitalization among older adults, associated with high mortality and frequent readmissions. Prealbumin has been proposed as a marker of nutritional status and systemic inflammation, while the PROFUND index stratifies long-term risk in multimorbid patients. However, the combined prognostic utility of both tools in AHF remains poorly defined.

To assess the individual and combined prognostic value of prealbumin levels and the PROFUND index in predicting 12-month mortality and hospital readmissions in elderly patients admitted for AHF.

We conducted a retrospective, observational study using data from the National RICA Registry. Patients aged≥65 years hospitalized for AHF with available prealbumin levels and PROFUND index at admission were included. Associations with 12-month mortality and readmission rates were analyzed using multivariate models, ROC curve analysis, and Kaplan-Meier survival estimates.

A total of 609 patients were included (median age 80 years, 61% female). Low prealbumin levels (<18mg/dL) were observed in 51% of patients. One-year mortality was significantly higher in the low prealbumin group (55.8 vs. 38.0%; p<0.001). The PROFUND index showed a progressive association with mortality risk (p<0.001). The combination of low prealbumin and high PROFUND index improved the prediction of all-cause mortality (AUC=0.685), but did not significantly impact readmission risk.

Both prealbumin levels and the PROFUND index independently predict mortality in elderly patients hospitalized for AHF. Their combined assessment may enhance risk stratification, identifying vulnerable subgroups with higher short-term mortality. Their predictive value for hospital readmissions appears limited.