{
  "abstract": "Background Malnutrition influences prognosis in patients with heart failure, but current nutritional evaluation methods are excessively complex for routine clinical use. The role of the serum albumin concentration, a widely used surrogate marker, in acute heart failure remains unclear. We assessed whether changes in serum albumin during heart failure hospitalisation can serve as a prognostic marker.Methods Among 14 847 patients in a nationwide heart failure registry in 2013, 5836 eligible patients (mean age: 77.7 years, 51.2% men) were categorised into two groups: the albumin-increase group (n=2048) and the no-albumin-increase group (n=3788). The incidences of primary (all-cause mortality) and secondary (a composite of cardiovascular death and rehospitalisation for worsening heart failure) outcomes were compared between the groups. The prognostic impact of serum albumin changes was also evaluated.Results The median follow-up period was 1545 days (95% CI 1535 to 1557 days). Event-free survival rates for clinical outcomes were higher in the albumin-increase group than in the no-albumin-increase group (primary outcome: 54.5% vs 45.4%, 95% CI 51.4% to 57.6% vs 42.9% to 47.8%, p<0.005; secondary outcome: 40.5% vs 36.9%, 95% CI 36.4% to 44% vs 34.1% to 39.6%, p<0.005). A generalised additive model revealed a linear relationship between serum albumin changes and prognosis; declines had a stronger negative effect than the positive impact of increases, but the change rate better reflected the relationship with prognosis. Survival classification and regression tree analysis indicated that a 25% decrease in the serum albumin concentration identified the most vulnerable population; even a 3% decrease was associated with worse outcomes.Conclusions Serum albumin changes during hospitalisation can predict prognosis in patients with heart failure, indicating potential as a target for interventions.",
  "authors": [
    {
      "affiliations": [
        "Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan"
      ],
      "name": "Keiko Fukino"
    },
    {
      "affiliations": [
        "Teikyo University Graduate School of Public Health, Tokyo, Japan"
      ],
      "name": "Satoshi Miyata"
    },
    {
      "affiliations": [
        "Department of Cardiovascular Medicine, Faculty of Medical Scineces, Kyusyu University, Fukuoka, Japan"
      ],
      "name": "Tomomi Ide"
    },
    {
      "affiliations": [
        "Department of Cardiovascular Medicine, Faculty of Medical Scineces, Kyusyu University, Fukuoka, Japan"
      ],
      "name": "Shouji Matsushima"
    },
    {
      "affiliations": [
        "Department of Cardiovascular Medicine, Faculty of Medical Scineces, Kyusyu University, Fukuoka, Japan",
        "Institute for Medical Engineering & Science (IMES), Massachusetts Institute of Technology, Cambridge, Massachusetts, USA",
        "International University of Health and Welfare, Fukuoka, Japan"
      ],
      "name": "Takeshi Tohyama"
    },
    {
      "affiliations": [
        "Department of Cardiovascular Medicine, Faculty of Medical Scineces, Kyusyu University, Fukuoka, Japan",
        "International University of Health and Welfare, Fukuoka, Japan",
        "Cardiovascular Disease Initiative, Broad Institute, Cambridge, Massachusetts, USA"
      ],
      "name": "Nobuyuki Enzan"
    },
    {
      "affiliations": [
        "Department of Cardiovascular Medicine, Faculty of Medical Scineces, Kyusyu University, Fukuoka, Japan",
        "International University of Health and Welfare, Fukuoka, Japan"
      ],
      "name": "Hiroyuki Tsutsui"
    },
    {
      "affiliations": [
        "Teikyo University Chiba Medical Center, Ichihara, Chiba, Japan"
      ],
      "name": "Fumitaka Nakamura"
    }
  ],
  "title": "Long-term prognostic impact of in-hospital serum albumin concentration changes in patients hospitalised for heart failure",
  "uid": "4059013a-f494-5ad3-9928-a864ae553db6"
}