Hypoalbuminemia is a frequent marker of increased mortality in cardiogenic shock
Por:
Jantti, T, Tarvasmaki, T, Harjola, VP, Javanainen, T, Tolppanen, H, Hongisto, M, Kataja, A, Banaszewski, M, Kober, L, Lassus, J, Mebazaa, A, Parissis, J, Silva-Cardoso, J, Sionis, A, Di Somma, S, Spinar, J, Koniari, K, Voumvourakis, A, Karavidas, A, Sans-Rosello, J, Vila, M, Duran-Cambra, A, Metra, M, Bulgari, M, Lazzarini, V, Parenica, J, Stipal, R, Ludka, O, Palsuva, M, Ganovska, E, Kubena, P, Lindholm, MG, Hassager, C, Backlund, T, Jurkko, R, Jarvinen, K, Nieminen, T, Pulkki, K, Soininen, L, Sund, R, Tierala, I, Tolonen, J, Varpula, M, Korva, T, Pitkala, A, Marino, R, Sousa, ASC, Paiva, M, Rangel, I, Almeida, R, Pinho, T, Maciel, MJ, Stepinska, J, Skrobisz, A, Goral, P
Publicada:
16 may 2019
Resumen:
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 (Delta P-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.
Filiaciones:
Jantti, T:
Univ Helsinki, Cardiol, Helsinki, Finland
Helsinki Univ Hosp, Heart & Lung Ctr, Dept Cardiol, Helsinki, Finland
Tarvasmaki, T:
Univ Helsinki, Cardiol, Helsinki, Finland
Helsinki Univ Hosp, Heart & Lung Ctr, Dept Cardiol, Helsinki, Finland
Harjola, VP:
Univ Helsinki, Emergency Med, Helsinki, Finland
Helsinki Univ Hosp, Dept Emergency Med & Serv, Helsinki, Finland
Javanainen, T:
Univ Helsinki, Cardiol, Helsinki, Finland
Helsinki Univ Hosp, Heart & Lung Ctr, Dept Cardiol, Helsinki, Finland
Tolppanen, H:
Univ Helsinki, Cardiol, Helsinki, Finland
Helsinki Univ Hosp, Heart & Lung Ctr, Dept Cardiol, Helsinki, Finland
Hongisto, M:
Univ Helsinki, Emergency Med, Helsinki, Finland
Helsinki Univ Hosp, Dept Emergency Med & Serv, Helsinki, Finland
Kataja, A:
Univ Helsinki, Emergency Med, Helsinki, Finland
Helsinki Univ Hosp, Dept Emergency Med & Serv, Helsinki, Finland
Banaszewski, M:
Inst Cardiol, Intens Cardiac Therapy Clin, Warsaw, Poland
Lassus, J:
Univ Helsinki, Cardiol, Helsinki, Finland
Helsinki Univ Hosp, Heart & Lung Ctr, Dept Cardiol, Helsinki, Finland
Mebazaa, A:
Univ Paris Diderot, INSERM, U942, Paris, France
Hop Lariboisiere, AP HP, Dept Anesthesia & Crit Care, Paris, France
Parissis, J:
Attikon Univ Hosp, Heart Failure Clin, Athens, Greece
Attikon Univ Hosp, Secondary Cardiol Dept, Athens, Greece
Silva-Cardoso, J:
Univ Porto, Sao Joao Hosp Ctr, Porto Med Sch, Dept Cardiol,CINTESIS, Porto, Portugal
Sionis, A:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Biomed Res Inst IIB SantPau, Intens Cardiac Care Unit,Cardiol Dept, Barcelona, Spain
Spinar, J:
Univ Hosp Brno, Dept Internal Med & Cardiol, Brno, Czech Republic
Jurkko, R:
Univ Helsinki, Cardiol, Helsinki, Finland
Helsinki Univ Hosp, Heart & Lung Ctr, Dept Cardiol, Helsinki, Finland
Pulkki, K:
Univ Turku, Turku Univ Hosp, Lab Div, Turku, Finland
Univ Turku, Dept Clin Chem, Turku, Finland
Gold, Green Published
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