Serum albumin and short-term risk for mortality and cardiovascular disease among HIV-infected veterans.
OBJECTIVE
We examined the short-term and long-term associations of serum albumin with mortality and cardiovascular disease among HIV-infected veterans.


METHODS
Retrospective cohort analysis using a national database of US veterans with HIV infection.


METHODS
This analysis evaluated all HIV-infected veterans in the Department of Veterans Affairs HIV Clinical Case Registry (CCR), a national database consisting of demographic, clinical, laboratory, pharmaceutical, and viral status data. There were 25 522 patients enrolled between 1986 and 2007. We evaluated the associations of baseline and time-updated serum albumin levels with all-cause mortality, atherosclerotic cardiovascular disease, and heart failure by multivariate proportional hazards models.


RESULTS
Over 21 years, there were 10 869 deaths; the cumulative mortality was 73.2 per 1000 person-years. After multivariate adjustment for covariates measured at baseline, the lowest category of serum albumin (<2.5 g/dl) was associated with a higher mortality risk compared with the highest category (>4 g/dl; hazard ratio 3.00; 2.67-3.37). When analyzed as a time-dependent model, the association strengthened substantially (15.1; 14.0-16.4). Findings were similar for atherosclerotic cardiovascular disease and heart failure. We stratified the baseline mortality model by year of follow-up and found that albumin was more strongly associated with deaths that occurred within 1 year of baseline (9.29; 7.85-11.0) than in the second (1.66; 1.18-2.33) or third (1.22; 0.77-1.96) year after measurement.


CONCLUSIONS
Among ambulatory HIV-infected patients, lower serum albumin levels are strongly predictive of mortality risk, particularly within 1 year.
School of Medicine, San Francisco VA Medical Center.
Joshua
J
Lang
Rebecca
R
Scherzer
Cristin C
CC
Weekley
Phyllis C
PC
Tien
Carl
C
Grunfeld
Michael G
MG
Shlipak
D002318:Cardiovascular Diseases / Q000097:blood / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000401:mortality*; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis*; D013997:Time Factors; D014481:United States; D014728:Veterans / Q000706:statistics & numerical data
D012709:Serum Albumin