Hypoalbuminemia is a frequent marker of increased mortality in cardiogenic shock

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CardShock Investigators , Jäntti , T , Tarvasmäki , T , Harjola , V-P , Parissis , J , Javanainen , T , Tolppanen , H , Jurkko , R , Hongisto , M , Kataja , A , Lassus , J , Jurkko , R , Jarvinen , K & Nieminen , T 2019 , ' Hypoalbuminemia is a frequent marker of increased mortality in cardiogenic shock ' PLoS One , vol. 14 , no. 5 , 0217006 . https://doi.org/10.1371/journal.pone.0217006

Title: Hypoalbuminemia is a frequent marker of increased mortality in cardiogenic shock
Author: Jäntti, Toni; Tarvasmäki, Tuukka; Harjola, Veli-Pekka; Parissis, John; Pulkki, Kari; Javanainen, Tuija; Tolppanen, Heli; Jurkko, Raija; Hongisto, Mari; Kataja, Anu; Sionis, Alessandro; Silva-Cardoso, Jose; Banaszewski, Marek; Spinar, Jindrich; Mebazaa, Alexandre; Lassus, Johan; Kober, Lars; Lassus, Johan; Mebazaa, Alexandre; Metra, Marco; Parissis, John; Silva-Cardoso, Jose; Sionis, Alessandro; Di Somma, Salvatore; Spinar, Jindrich; Koniari, Katerina; Voumvourakis, Astrinos; Karavidas, Apostolos; Sans-Rosello, Jordi; Vila, Montserrat; Duran-Cambra, Albert; Metra, Marco; Bulgari, Michela; Lazzarini, Valentina; Parenica, Jiri; Stipal, Roman; Ludka, Ondrej; Palsuva, Marie; Ganovska, Eva; Kubena, Petr; Lindholm, Matias G.; Jurkko, Raija; Jarvinen, Kristiina; Nieminen, Tuomo; Pulkki, Kari; Soininen, Leena; Sund, Reijo; Tierala, Ilkka; Tolonen, Jukka; Varpula, Marjut
Contributor: University of Helsinki, HUS Heart and Lung Center
University of Helsinki, Clinicum
University of Helsinki, HUS Emergency Medicine and Services
University of Helsinki, HUS Heart and Lung Center
University of Helsinki, HUS Heart and Lung Center
University of Helsinki, Department of Medicine
University of Helsinki, Department of Diagnostics and Therapeutics
University of Helsinki, Department of Diagnostics and Therapeutics
University of Helsinki, HUS Heart and Lung Center
University of Helsinki, HUS Heart and Lung Center
University of Helsinki, Department of Medicine
University of Helsinki, Clinicum
University of Helsinki, HUS Internal Medicine and Rehabilitation
University of Helsinki, Kliinisen kemian yksikkö (-2009)
University of Helsinki, Department of Diagnostics and Therapeutics
University of Helsinki, University Management
University of Helsinki, Kardiologian yksikkö
University of Helsinki, Department of Medicine
University of Helsinki, Department of Medicine
Date: 2019-05-16
Number of pages: 14
Belongs to series: PLoS One
ISSN: 1932-6203
URI: http://hdl.handle.net/10138/304604
Abstract: Introduction The prevalence of hypoalbuminemia, early changes of plasma albumin (P-Alb) levels, and their effects on mortality in cardiogenic shock are unknown. Materials and methods P-Alb was measured from serial blood samples in 178 patients from a prospective multinational study on cardiogenic shock. The association of hypoalbuminemia with clinical characteristics and course of hospital stay including treatment and procedures was assessed. The primary outcome was all-cause 90-day mortality. Results Hypoalbuminemia (P-Alb < 34g/L) was very frequent (75%) at baseline in patients with cardiogenic shock. Patients with hypoalbuminemia had higher mortality than patients with normal albumin levels (48% vs. 23%, p = 0.004). Odds ratio for death at 90 days was 2.4 [95% CI 1.5–4.1] per 10 g/L decrease in baseline P-Alb. The association with increased mortality remained independent in regression models adjusted for clinical risk scores developed for cardiogenic shock (CardShock score adjusted odds ratio 2.0 [95% CI 1.1–3.8], IABP-SHOCK II score adjusted odds ratio 2.5 [95%CI 1.2–5.0]) and variables associated with hypoalbuminemia at baseline (adjusted odds ratio 2.9 [95%CI 1.2–7.1]). In serial measurements, albumin levels decreased at a similar rate between 0h and 72h in both survivors and nonsurvivors (ΔP-Alb -4.6 g/L vs. 5.4 g/L, p = 0.5). While the decrease was higher for patients with normal P-Alb at baseline (p<0.001 compared to patients with hypoalbuminemia at baseline), the rate of albumin decrease was not associated with outcome. Conclusions Hypoalbuminemia was a frequent finding early in cardiogenic shock, and P-Alb levels decreased during hospital stay. Low P-Alb at baseline was associated with mortality independently of other previously described risk factors. Thus, plasma albumin measurement should be part of the initial evaluation in patients with cardiogenic shock. Trial registration NCT01374867 at ClinicalTrials.gov.
Subject: SERUM-ALBUMIN CONCENTRATION
LEVELS PREDICT SURVIVAL
HEART-FAILURE
MYOCARDIAL-INFARCTION
PROGNOSTIC VALUE
RISK PREDICTION
ASSOCIATION
MANAGEMENT
ADMISSION
LEVEL
3121 Internal medicine
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