title: Serum albumin changes and multivariate dynamic risk modelling in chronic heart failure.
abstract: BACKGROUND
  We examined the prognostic utility of rate of change in serum albumin over time in chronic heart failure (CHF), as well as the utility of multivariate dynamic risk modelling.
  
  
  RESULTS
  The survival implication of ∆albumin was analysed in 232 systolic CHF patients and validated in 212 patients. A multivariate dynamic risk score predicated on the rate of change in 6 simple indices including albumin was calculated and related to mortality. In derivation patients, 50 (22%) deaths occurred over 13 months. Greater rates of decline in albumin related to higher mortality (HR 0.55, 95% CI 0.41-0.73, P<0.0001) independently, incrementally and more accurately than other covariates including baseline albumin. A rate of attenuation >0.4 g/dL/month optimally forecasted death and was associated with a 5-fold escalated risk of mortality (HR 5.13, 95% CI 2.92-9.00, P<0.0001). Similar results were seen in the validation cohort. On multivariate dynamic risk modelling, survival at 1-year worsened with higher scores-a score ≥ 3 was associated with a 12-fold greater risk of death than a score of 0, a 6-fold higher risk of death than a score of 1, and a 4-fold enhanced risk of mortality than a score of 2.
  
  
  CONCLUSIONS
  Attenuations in serum albumin over time relate to increased mortality in CHF, and a risk model predicated on the rate of change in 6 simple indices can identify patients at a 12-fold enhanced risk of death over the coming year.
authors.affiliation: International Centre for Circulatory Health, NHLI, Imperial College, London, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Jabbour
authors.affiliation: University College London Hospital, London, UK.
authors.forename: Hua Zen
authors.initials: HZ
authors.lastname: Ling
authors.affiliation: International Centre for Circulatory Health, NHLI, Imperial College, London, UK.
authors.forename: Karl
authors.initials: K
authors.lastname: Norrington
authors.affiliation: International Centre for Circulatory Health, NHLI, Imperial College, London, UK.
authors.forename: Nelson
authors.initials: N
authors.lastname: Amaral
authors.affiliation: International Centre for Circulatory Health, NHLI, Imperial College, London, UK.
authors.forename: Nabeela
authors.initials: N
authors.lastname: Zaman
authors.affiliation: University College London Hospital, London, UK; The Heart Hospital, London, UK.
authors.forename: Suneil
authors.initials: S
authors.lastname: Aggarwal
authors.affiliation: University College London Hospital, London, UK.
authors.forename: Nay
authors.initials: N
authors.lastname: Aung
authors.affiliation: International Centre for Circulatory Health, NHLI, Imperial College, London, UK.
authors.forename: Anthony
authors.initials: A
authors.lastname: Barron
authors.affiliation: International Centre for Circulatory Health, NHLI, Imperial College, London, UK.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Manisty
authors.affiliation: The Heart Hospital, London, UK.
authors.forename: Resham
authors.initials: R
authors.lastname: Baruah
authors.affiliation: International Centre for Circulatory Health, NHLI, Imperial College, London, UK.
authors.forename: Graham D
authors.initials: GD
authors.lastname: Cole
authors.affiliation: Wexham Park Hospital, Slough, UK.
authors.forename: Constantinos G
authors.initials: CG
authors.lastname: Missouris
authors.affiliation: International Centre for Circulatory Health, NHLI, Imperial College, London, UK.
authors.forename: Jamil
authors.initials: J
authors.lastname: Mayet
authors.affiliation: International Centre for Circulatory Health, NHLI, Imperial College, London, UK.
authors.forename: Darrel P
authors.initials: DP
authors.lastname: Francis
authors.affiliation: Kettering General Hospital, Kettering, UK.
authors.forename: Adrian S
authors.initials: AS
authors.lastname: Cheng
authors.affiliation: University College London Hospital, London, UK; The Heart Hospital, London, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Thomas
authors.affiliation: University College London Hospital, London, UK; The Heart Hospital, London, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Woldman
authors.affiliation: International Centre for Circulatory Health, NHLI, Imperial College, London, UK; University College London Hospital, London, UK; The Heart Hospital, London, UK. Electronic address: obiokonko@aol.com.
authors.forename: Darlington O
authors.initials: DO
authors.lastname: Okonko
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism*; D015996:Survival Rate / Q000639:trends
chemical_list: D015415:Biomarkers; D012709:Serum Albumin
keywords: Albumin; Heart failure; Prognosis