| ObjectiveTo evaluate the effect of serum albumin on prognosis and the power of albumin adding information to NT-proBNP in a Chinese cohort of heart failure.Methods385consecutive patients (male vs. female:292vs.93; mean age:54.89±14.41years; NYHA class Ⅱ-Ⅴ) admitted for heart failure exacerbation with LVEF≤45%were enrolled. Excluded criteria:acute coronary syndrome, acute myocarditis, hepatobiliary diseases, creatinine265μmol/L or more, life expectancy less than2years caused by non-cardiac disease (e.g. malignancy), drug-induced liver dysfunction, severe infection(such as infective endocarditis, severe pneumonia, etc.), and other serious systemic diseases. Biochemical data were measured at baseline. The endpoint was defined as cardiac death or rehospitalization for aggravated heart failure. Follow-up period was25±7months.ResultsIn the univariate analysis, the significant clinical variables were total bilirubin (T-Bil), direct bilirubin (D-Bil), heart rate, NYHA functional class, NT-proBNP, creatinine, lymphocytes count, neutrophil count, serum sodium concentration, serum chloride concentration, uric acid concentration (UA), LVEF, size of right ventricle (RV) and size of left atrium (LA). Multivariate analysis in a Cox proportional hazard model revealed serum albumin was an independent predictor for adverse prognosis (HR0.96,CI0.94-0.99, P=0.02), and other independent risk factors were serum creatinine (HR1.01,CI1.00-1.01,P<0.01), serum sodium (HR0.92, CI0.88-0.97, P<0.01), NT-proBNP (HR1.01,CI1.00-1.02,P=0.01), and serum T-bil (HR1.01,CI1.00-1.02, P<0.01). In the process we testified the additional role of albumin on prognosis of heart failure patients, we stratified the whole population into4groups according to the median of serum albumin (40.20g/L) and NT-proBNP (2125.50fmol/ml), using cox-proportion hazard model to calculate the hazard risk of each group respectively. Then we found that patients with higher NT-proBNP and lower albumin than median (n=128) had the highest risk for cardiac events (HR2.890, CI1.90-4.40, P<0.001), Meanwhile, the hazard ratio of the group (n=74) with NT-proBNP>2125.50fmol/ml and albumin>40.20g/L was2.497(CI1.55-4.04, P<0.01). The hazard ratio of the group (n=68) with NT-proBNP<2125.50fmol/ml and albumin<40.20g/L was2.119(CI1.30-3.45, P<0.01).ConclusionSerum albumin is a useful prognosis indicator for heart failure and it adds important information to NT-proBNP. ObjectiveTo evaluate the effect of serum T-bil and D-bil on prognosis of heart failure in Chinese population and testify the power of serum T-bil and D-bil adding information to NT-proBNP in a Chinese cohort of heart failure.Methods392consecutive patients with heart failure exacerbation admitted to Fuwai Hospital were enrolled. Plasma concentrations of NT-proBNP, serum T-bil, D-bil and other biochemical categories were measured at baseline. The endpoint was defined as cardiac death and rehospitalization for aggravated heart failure.ResultsIn the univariate analysis, the significant clinical variables were T-Bil, D-Bil, heart rate, NYHA class, NT-proBNP, creatinine, lymphocytes count, neutrophil count, serum sodium, serum chloride, uric acid (UA), left ventricular ejection fraction (LVEF), the size of right ventricular and size of left atrium. Cox proportional hazard analysis revealed that serum T-Bil (HR1.009, p=0.017, CI1.002-1.017) and D-bil (HR1.021, p=0.011, CI1.005-1.037) were independent predictors of subsequent cardiac events after hospital discharge. When the cohort was stratified according to median T-bil and NT-proBNP concentrations, and to median D-bil and NT-proBNP concentrations, respectively, Cox proportional-hazards regression analyses showed the highest risk for cardiac events in patients with both increased T-bil and NT-proBNP (HR1.668,p=0.004,CI1.180-2.414), and increased D-bil and NT-proBNP (HR2.748,P<0.001,CI1.859-4.060).ConclusionOur study demonstrates that serum T-bil and D-bil are independent prognosis indicator and increased serum T-bil and D-bil concentrations provide prognosis information in addition to NT-proBNP measurement for patients with heart failure. |
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