title: Clinical Implications of Serum Albumin Levels in Acute Heart Failure: Insights From DOSE-AHF and ROSE-AHF.
abstract: BACKGROUND
  Hypoalbuminemia is common in patients with chronic heart failure and, as a marker of disease severity, is associated with an adverse prognosis. Whether hypoalbuminemia contributes to (or is associated with) worse outcomes in acute heart failure (AHF) is unclear. We sought to determine the implications of low serum albumin in patients receiving decongestive therapies for AHF.
  
  
  RESULTS
  Baseline serum albumin levels were measured in 456 AHF subjects randomized in the DOSE-AHF and ROSE-AHF trials. We assessed the relationship between admission albumin levels (both as a continuous variable and stratified by median albumin [≥3.5 g/dL]) and worsening renal function (WRF), worsening heart failure (WHF), and clinical decongestion by 72 hours; 7-day cardiorenal biomarkers; and post-discharge outcomes. The mean baseline albumin level was 3.5 ± 0.5 g/dL. Albumin was not associated with WRF, WHF, or clinical decongestion by 72 hours. Furthermore, there was no association between continuous albumin levels and symptom change according to visual analog scale or weight change by 72 hours. Albumin was not associated with 60-day mortality, rehospitalization, or unscheduled emergency room visits.
  
  
  CONCLUSIONS
  Baseline serum albumin levels were not associated with short-term clinical outcomes for AHF patients undergoing decongestive therapies. These data suggest that serum albumin may not be a helpful tool to guide decongestion strategies.
authors: Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors: Justin L
authors: JL
authors: Grodin
authors: Department of Advanced Heart Disease, Brigham and Women's Hospital, Boston, Massachusetts; Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Medical Center, New York, New York.
authors: Anuradha
authors: A
authors: Lala
authors: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors: Susanna R
authors: SR
authors: Stevens
authors: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina; Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors: Adam D
authors: AD
authors: DeVore
authors: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina; Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors: Lauren B
authors: LB
authors: Cooper
authors: Department of Medicine, Division of Cardiology, Mayo Clinic, Rochester, Minnesota.
authors: Omar F
authors: OF
authors: AbouEzzeddine
authors: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina; Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors: Robert J
authors: RJ
authors: Mentz
authors: Department of Advanced Heart Disease, Brigham and Women's Hospital, Boston, Massachusetts.
authors: John D
authors: JD
authors: Groarke
authors: Department of Advanced Heart Disease, Brigham and Women's Hospital, Boston, Massachusetts.
authors: Emer
authors: E
authors: Joyce
authors: Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors: Julie L
authors: JL
authors: Rosenthal
authors: Department of Medicine, Division of Cardiology, Washington University School of Medicine, St Louis, Missouri.
authors: Justin M
authors: JM
authors: Vader
authors: Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: tangw@ccf.org.
authors: W H Wilson
authors: WH
authors: Tang
mesh_terms: D000208:Acute Disease; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death; D016009:Chi-Square Distribution; D004232:Diuretics / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D017052:Hospital Mortality; D006801:Humans; D007677:Kidney Function Tests; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D051437:Renal Insufficiency / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology*; D018570:Risk Assessment; D012709:Serum Albumin / Q000032:analysis*; D012720:Severity of Illness Index; D016019:Survival Analysis; D014481:United States
chemical_list: D015415:Biomarkers; D004232:Diuretics; D012709:Serum Albumin
keywords: Heart failure; diuretics; proteins