title: Usefulness of serum albumin and serum total cholesterol in the prediction of hospital death in older patients with severe, acute heart failure.
abstract: BACKGROUND
  Acute heart failure (HF) carries high hospital mortality rates in older patients; a multimarker strategy may help identify patients at high risk.
  
  
  OBJECTIVE
  To investigate prospectively the prognostic relevance of serum albumin and serum total cholesterol (TC) in older patients with severe, acute HF.
  
  
  METHODS
  Usual prognostic variables were collected on admission in 207 consecutive patients aged>70 years with severe, acute HF. Serum albumin and serum TC were obtained soon after clinical improvement.
  
  
  RESULTS
  Hospital mortality rate was 19%. Patients who died were similar to patients who survived in terms of age, sex, heart rate, serum haemoglobin and left ventricular ejection fraction. Patients who died had higher concentrations of B-type natriuretic peptide (BNP), blood urea nitrogen, serum creatinine, C-reactive protein and serum troponin I, lower systolic blood pressure, and lower concentrations of serum albumin and serum TC than patients who survived (P<0.01 for all). Serum albumin was the best independent predictor of hospital death (odds ratio 0.82 [0.74-0.90], P<0.001), with blood urea nitrogen (P=0.02) and log (BNP) (P=0.02). A simple risk score based on serum albumin (<3g/dL; 2 points), BNP (>840pg/mL; 1 point) and blood urea nitrogen (>15.3mmol/L; 1 point) discriminated patients without (score 0 to 1, hospital death 4%) from patients with (score 2 to 4, hospital death 35%, P<0.001) a high risk of death.
  
  
  CONCLUSIONS
  Hypoalbuminaemia offers powerful additional prognostic information to usual prognostic variables in older patients with severe, acute HF, and deserves further attention in multimarker strategies.
authors: Department of Cardiology, Aubagne Hospital, France. sarques@ch-aubagne.fr
authors: Stephane
authors: S
authors: Arques
authors: Emmanuel
authors: E
authors: Roux
authors: Philippe
authors: P
authors: Stolidi
authors: Richard
authors: R
authors: Gelisse
authors: Pierre
authors: P
authors: Ambrosi
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D016009:Chi-Square Distribution; D002784:Cholesterol / Q000097:blood*; D005260:Female; D005602:France / Q000453:epidemiology; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D017052:Hospital Mortality; D006764:Hospitals, Community; D006801:Humans; D034141:Hypoalbuminemia / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D007902:Length of Stay; D008297:Male; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D018570:Risk Assessment; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis*; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D012709:Serum Albumin; D002784:Cholesterol