Table 1. Patient characteristics.
| Increase in albumin (N = 1083, 34.3%) | No-increase in albumin (N = 2077, 65.7%) | P value | N of patients analyzed | |
|---|---|---|---|---|
| Clinical characteristics | ||||
| Age, years | 78 [68–84] | 81 [74–87] | <0.0001 | 3,160 |
| Age >80 years* | 475 (43.9) | 1174 (56.5) | <0.0001 | 3,160 |
| Men* | 623 (57.5) | 1125 (54.2) | 0.08 | 3,160 |
| Body mass index || <22 kg/m2* | 448 (42.8) | 950 (48.4) | 0.003 | 3,009 |
| Prior hospitalization for heart failure* | 373 (34.8) | 747 (36.4) | 0.39 | 3,124 |
| Etiology | ||||
| Dilated cardiomyopathy | 162 (15.0) | 178 (8.6) | <0.0001 | 3,160 |
| Acute coronary syndrome* | 53 (4.9) | 120 (5.8) | 0.32 | 3,160 |
| Aortic stenosis | 63 (5.8) | 160 (7.7) | 0.057 | 3,160 |
| Hypertensive | 255 (23.6) | 538 (25.9) | 0.15 | 3,160 |
| Ischemic (not acute) | 278 (25.7) | 580 (27.9) | 0.18 | 3,160 |
| Others | 272 (25.1) | 501 (24.1) | 0.54 | 3,160 |
| Medical history | ||||
| Atrial fibrillation or flutter* | 444 (41.0) | 874 (42.1) | 0.57 | 3,160 |
| Hypertension* | 747 (69.0) | 1564 (75.3) | 0.0002 | 3,160 |
| Diabetes mellitus* | 408 (37.7) | 788 (37.9) | 0.91 | 3,160 |
| Dyslipidemia | 445 (41.1) | 809 (39.0) | 0.25 | 3,160 |
| Prior myocardial infarction* | 244 (22.5) | 482 (23.2) | 0.69 | 3,160 |
| Prior stroke* | 180 (16.6) | 332 (16.0) | 0.65 | 3,160 |
| Current smoking* | 165 (15.4) | 215 (10.6) | 0.0001 | 3,104 |
| Ventricular tachycardia/fibrillation | 54 (5.0) | 71 (3.4) | 0.03 | 3,160 |
| Chronic lung disease* | 136 (12.6) | 291 (14.0) | 0.27 | 3,160 |
| Liver cirrhosis* | 12 (1.1) | 28 (1.4) | 0.62 | 3,160 |
| Malignancy* | 133 (12.3) | 328 (15.8) | 0.008 | 3,160 |
| Social backgrounds | ||||
| Poor medical adherence | 208 (19.2) | 339 (16.3) | 0.048 | 3,160 |
| Living alone* | 244 (22.5) | 422 (20.3) | 0.15 | 3,160 |
| Daily life activities | ||||
| Ambulatory* | 861 (80.1) | 1627 (79.1) | 0.55 | 3,132 |
| Use of wheelchair [outdoor only] | 83 (7.7) | 159 (7.7) | 1.00 | 3,132 |
| Use of wheelchair [outdoor and indoor] | 97 (9.0) | 193 (9.4) | 0.80 | 3,132 |
| Bedridden | 34 (3.2) | 78 (3.8) | 0.42 | 3,132 |
| Vital signs at presentation | ||||
| Systolic blood pressure, mmHg | 145 ± 33 | 150 ± 36 | 0.0001 | 3,149 |
| Systolic blood pressure <90 mmHg* | 33 (3.1) | 45 (2.2) | 0.15 | 3,153 |
| Heart rate, bpm | 97 ± 29 | 96 ± 27 | 0.45 | 3,142 |
| Heart rate <60 bpm* | 78 (7.2) | 137 (6.6) | 0.55 | 3,142 |
| Body temperature>37.5 degree Celsius | 55 (5.3) | 141 (7.1) | 0.06 | 3,033 |
| NYHA Class III or IV | 917 (85.0) | 1838 (88.9) | 0.0021 | 3,147 |
| Tests at presentation | ||||
| LVEF | 46.0 ± 16.4 | 46.6 ± 16.1 | 0.35 | 3,086 |
| HFrEF (LVEF <40%)* | 397 (36.7) | 761 (36.8) | 1.00 | 3,153 |
| HFmrEF (LVEF 40–49%) | 240 (22.2) | 372 (18.0) | 0.005 | 3,153 |
| HFpEF (LVEF ≥50%) | 445 (41.1) | 938 (45.3) | 0.026 | 3,153 |
| BNP, ng/L | 691 [378–1245] | 724 [395–1268] | 0.21 | 2,811 |
| Serum creatinine, mg/dL | 1.05 [0.80–1.50] | 1.12 [0.83–1.67] | 0.0006 | 3,160 |
| eGFR <30 mL/min/1.73m2* | 241 (22.3) | 604 (29.1) | <0.0001 | 3,160 |
| Blood urea nitrogen, mg/dL | 22 [16–32] | 25 [18–37] | <0.0001 | 3,157 |
| Sodium <135 mEq/L* | 126 (11.7) | 255 (12.3) | 0.61 | 3,155 |
| Anemia*§ | 740 (68.4) | 1374 (66.2) | 0.23 | 3,157 |
| C reactive protein, mg/dL | 0.69 [0.22–2.57] | 0.60 [0.20–1.85] | 0.0001 | 3,103 |
| Increase in albumin levels, g/dl☨ | ||||
| Albumin levels at presentation, g/dl *# | 3.25 ± 0.48 | 3.58 ± 0.45 | <0.0001 | 3,160 |
| Q1: ≤ 3.2 g/dl | 524 (48.4) | 463 (22.3) | <0.0001 | 987 |
| Q2: > 3.2 g/dl and ≤ 3.5 g/dl | 262 (24.2) | 451 (21.7) | 0.17 | 713 |
| Q3: ≥3.5 g/dl and ≤ 3.8 g/dl | 193 (17.8) | 555 (26.7) | <0.0001 | 748 |
| Q4: > 3.8 g/dl | 104 (9.6) | 608 (29.3) | <0.0001 | 712 |
| Medications at discharge | ||||
| ACE-I or ARB* | 634 (58.5) | 1177 (56.7) | 0.31 | 3,160 |
| Beta blocker* | 740 (68.3) | 1358 (65.4) | 0.10 | 3,160 |
| MRA | 520 (48.0) | 898 (43.2) | 0.010 | 3,160 |
| Diuretics (non-MRA) | 945 (87.2) | 1694 (81.6) | <0.0001 | 3,160 |
| BNP at discharge, ng/L | 231 [118–475] | 299 [147–543] | <0.0001 | 2,148 |
| Hospital stay >16 days* (median) | 557 (51.4%) | 979 (47.1%) | 0.02 | 3,160 |
*26 risk-adjusting variables selected for COX hazard model including albumin quartiles.
|| Body mass index was calculated as weight in kilograms divided by height in meters squared.
§ Anemia was defined by the World Health Organization criteria (hemoglobin <12.0 g/dL in women and <13.0 g/dL in men).
☨ Any increase in albumin level corresponded to albumin increase.
#Albumin levels at admission were classified into quartiles: ≤ 3.2 g/dl (Q1), > 3.2 g/dl and ≤ 3.5 g/dl (Q2), ≥3.5 g/dl and ≤ 3.8 g/dl (Q3), and > 3.8 g/dl (Q4).
BP = blood pressure; bpm = beat per minute; NYHA = New York Heart Association, LVEF = left ventricular ejection fraction; HFrEF = heart failure with reduced ejection fraction; HFmrEF = heart failure with mid-range ejection fraction; HFpEF = heart failure with preserved ejection fraction; BNP = brain-type natriuretic peptide; eGFR = estimated glomerular filtration rate, ACE-I = angiotensin converting enzyme inhibitors, ARB = angiotensin II receptor blockers, MRA = mineralocorticoid receptor antagonist.