Hypoalbuminemia is a frequent marker of increased mortality in cardiogenic shock
Jäntti, Toni (Helsinki University Hospital (Finlàndia))
Tarvasmäki, Tuukka (Helsinki University Hospital (Finlàndia))
Harjola, Veli-Pekka (Helsinki University Hospital (Finlàndia))
Parissis, J. (University General Hospital Attikon (Haidari, Grècia))
Pulkki, Kari (Turku University Hospital (Finlàndia))
Javanainen, T. (Helsinki University Hospital (Finlàndia))
Tolppanen, Heli (Helsinki University Hospital (Finlàndia))
Jurkko, Raija (Helsinki University Hospital (Finlàndia))
Hongisto, Mari (Helsinki University Hospital (Finlàndia))
Kataja, Anu (Helsinki University Hospital (Finlàndia))
Sionis, Alessandro (Institut d'Investigació Biomèdica Sant Pau)
Silva-Cardoso, J. (Department of Cardiology. CINTESIS. Porto Medical School. São João Hospital Center. University of Porto)
Banaszewski, Marek (Intensive Cardiac Therapy Clinic. Institute of Cardiology)
Spinar, J. (University Hospital Brno (República Txeca))
Mebazaa, Alexandre (INSERM U942. University Paris Diderot. Department of Anesthesia and Critical Care. Hôpital Lariboisière. APHP)
Lassus, J. (Helsinki University Hospital (Finlàndia))
Universitat Autònoma de Barcelona

Data:	2019
Resum:	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. Theprimary 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], IABPSHOCK 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 andnonsurvivors (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.
Nota:	Altres ajuts: VPH was supported by the Aarne Koskelo Foundation (no grant number): http://www. aarnekoskelonsaatio.fi/, and the Finnish Cardiac Foundation (no grant number): https://www. fincardio.fi/. Laboratory kits were provided by Roche Diagnostics. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Publicat a:	PloS one, Vol. 14 Núm. 5 (may 2019) , p. e0217006, ISSN 1932-6203

DOI: 10.1371/journal.pone.0217006
PMID: 31095609

14 p, 796.0 KB

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