title: Low prealbumin is strongly associated with adverse outcome in heart failure.
abstract: OBJECTIVE
  Prealbumin is one of the best indicators of nutritional status. We previously showed that prealbumin predicted in-hospital mortality in heart failure (HF) patients. We evaluated if a low discharge prealbumin after admission with acute HF would predict morbidity and mortality.
  
  
  METHODS
  We conducted a prospective observational study. Patients admitted with a primary diagnosis of HF were studied. Follow-up was up to 6 months. Endpoints analysed were: all-cause and HF-death; all-cause and worsening HF hospitalisation. Patients with discharge prealbumin ≤15.0 mg/dL and those with prealbumin >15 mg/dL were compared. A Cox-regression analysis was used to evaluate the prognostic impact of low prealbumin.
  
  
  RESULTS
  We studied 514 patients. Mean age was 78 years and 45.7% were male. During follow-up, 101 patients died (78 for HF) and 209 patients were hospital readmitted (140 for worsening HF). Median prealbumin was 20.1 (15.3-25.3) mg/dL. Patients with lower prealbumin were more often women, older aged and with non-ischaemic HF; they had lower albumin, haemoglobin and total cholesterol; and higher glomerular filtration rate, C-reactive protein, B-type natriuretic peptide and length of hospital stay. Lower prealbumin associated with less β-blocker and statin use. Patients with discharge prealbumin ≤15 mg/dL had a multivariate adjusted HR of 6-month all-cause and HF death of 1.67 (1.00 to 2.80) and 2.12 (1.19 to 3.79) respectively and of all-cause and HF readmission of 1.47 (1.01 to 2.14) and 1.58 (1.01 to 2.47).
  
  
  CONCLUSIONS
  Patients with discharge prealbumin ≤15 mg/dL have an higher risk of 6 months morbidity and mortality. The unbalance between protein-energy demands and its availability predicts ominous HF outcome.
authors.affiliation: Serviço de Medicina Interna, Centro Hospitalar São João, Faculdade de Medicina da Universidade do Porto, Unidade I&D Cardiovascular do Porto, Porto, Portugal.
authors.forename: Patrícia
authors.initials: P
authors.lastname: Lourenço
authors.affiliation: Serviço de Medicina Interna, Centro Hospitalar São João, Faculdade de Medicina da Universidade do Porto, Unidade I&D Cardiovascular do Porto, Porto, Portugal.
authors.forename: Sérgio
authors.initials: S
authors.lastname: Silva
authors.affiliation: Serviço de Medicina Interna, Centro Hospitalar São João, Faculdade de Medicina da Universidade do Porto, Unidade I&D Cardiovascular do Porto, Porto, Portugal.
authors.forename: Fernando
authors.initials: F
authors.lastname: Friões
authors.affiliation: Serviço de Medicina Interna, Centro Hospitalar São João, Faculdade de Medicina da Universidade do Porto, Unidade I&D Cardiovascular do Porto, Porto, Portugal.
authors.forename: Margarida
authors.initials: M
authors.lastname: Alvelos
authors.affiliation: Serviço de Medicina Interna, Centro Hospitalar São João, Faculdade de Medicina da Universidade do Porto, Unidade I&D Cardiovascular do Porto, Porto, Portugal.
authors.forename: Marta
authors.initials: M
authors.lastname: Amorim
authors.affiliation: Serviço de Medicina Interna, Centro Hospitalar São João, Faculdade de Medicina da Universidade do Porto, Unidade I&D Cardiovascular do Porto, Porto, Portugal.
authors.forename: Marta
authors.initials: M
authors.lastname: Couto
authors.affiliation: Serviço de Medicina Interna, Centro Hospitalar São João, Faculdade de Medicina da Universidade do Porto, Unidade I&D Cardiovascular do Porto, Porto, Portugal.
authors.forename: Paulo
authors.initials: P
authors.lastname: Torres-Ramalho
authors.affiliation: Serviço de Patologia Clínica, Centro Hospitalar São João, Faculdade de Medicina da Universidade do Porto, Porto, Portugal Departamento de Bioquímica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
authors.forename: João Tiago
authors.initials: JT
authors.lastname: Guimarães
authors.affiliation: Serviço de Medicina Interna, Centro Hospitalar São João, Faculdade de Medicina da Universidade do Porto, Unidade I&D Cardiovascular do Porto, Porto, Portugal.
authors.forename: José Paulo
authors.initials: JP
authors.lastname: Araújo
authors.affiliation: Serviço de Medicina Interna, Centro Hospitalar São João, Faculdade de Medicina da Universidade do Porto, Unidade I&D Cardiovascular do Porto, Porto, Portugal.
authors.forename: Paulo
authors.initials: P
authors.lastname: Bettencourt
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000401:mortality* / Q000628:therapy; D017052:Hospital Mortality / Q000639:trends*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D011174:Portugal; D011228:Prealbumin / Q000032:analysis*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D011228:Prealbumin
keywords: Heart Failure