Hypoalbuminemia is a frequent marker of increased mortality in cardiogenic shock

CardShock Investigators, Toni Jäntti, Tuukka Tarvasmäki, Veli-Pekka Harjola, John Parissis, Tuija Javanainen, Heli Tolppanen, Raija Jurkko, Mari Hongisto, Anu Kataja, Johan Lassus, Raija Jurkko, Kristiina Jarvinen, Tuomo Nieminen

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Introduction The prevalence of hypoalbuminemia, early changes of plasma albumin (P-Alb) levels, and their effects on mortality in cardiogenic shock are unknown. Materials and methods P-Alb was measured from serial blood samples in 178 patients from a prospective multinational study on cardiogenic shock. The association of hypoalbuminemia with clinical characteristics and course of hospital stay including treatment and procedures was assessed. The primary outcome was all-cause 90-day mortality. Results Hypoalbuminemia (P-Alb < 34g/L) was very frequent (75%) at baseline in patients with cardiogenic shock. Patients with hypoalbuminemia had higher mortality than patients with normal albumin levels (48% vs. 23%, p = 0.004). Odds ratio for death at 90 days was 2.4 [95% CI 1.5–4.1] per 10 g/L decrease in baseline P-Alb. The association with increased mortality remained independent in regression models adjusted for clinical risk scores developed for cardiogenic shock (CardShock score adjusted odds ratio 2.0 [95% CI 1.1–3.8], IABP-SHOCK II score adjusted odds ratio 2.5 [95%CI 1.2–5.0]) and variables associated with hypoalbuminemia at baseline (adjusted odds ratio 2.9 [95%CI 1.2–7.1]). In serial measurements, albumin levels decreased at a similar rate between 0h and 72h in both survivors and nonsurvivors (ΔP-Alb -4.6 g/L vs. 5.4 g/L, p = 0.5). While the decrease was higher for patients with normal P-Alb at baseline (p<0.001 compared to patients with hypoalbuminemia at baseline), the rate of albumin decrease was not associated with outcome. Conclusions Hypoalbuminemia was a frequent finding early in cardiogenic shock, and P-Alb levels decreased during hospital stay. Low P-Alb at baseline was associated with mortality independently of other previously described risk factors. Thus, plasma albumin measurement should be part of the initial evaluation in patients with cardiogenic shock. Trial registration NCT01374867 at ClinicalTrials.gov.
Original languageEnglish
Article number0217006
JournalPLoS One
Volume14
Issue number5
Number of pages14
ISSN1932-6203
DOIs
Publication statusPublished - 16 May 2019
MoE publication typeA1 Journal article-refereed

Fields of Science

  • SERUM-ALBUMIN CONCENTRATION
  • LEVELS PREDICT SURVIVAL
  • HEART-FAILURE
  • MYOCARDIAL-INFARCTION
  • PROGNOSTIC VALUE
  • RISK PREDICTION
  • ASSOCIATION
  • MANAGEMENT
  • ADMISSION
  • LEVEL
  • 3121 Internal medicine

Cite this

CardShock Investigators ; Jäntti, Toni ; Tarvasmäki, Tuukka ; Harjola, Veli-Pekka ; Parissis, John ; Javanainen, Tuija ; Tolppanen, Heli ; Jurkko, Raija ; Hongisto, Mari ; Kataja, Anu ; Lassus, Johan ; Jurkko, Raija ; Jarvinen, Kristiina ; Nieminen, Tuomo. / Hypoalbuminemia is a frequent marker of increased mortality in cardiogenic shock. In: PLoS One. 2019 ; Vol. 14, No. 5.
@article{be29d9889bac4f849867b245b5c2c310,
title = "Hypoalbuminemia is a frequent marker of increased mortality in cardiogenic shock",
abstract = "Introduction The prevalence of hypoalbuminemia, early changes of plasma albumin (P-Alb) levels, and their effects on mortality in cardiogenic shock are unknown. Materials and methods P-Alb was measured from serial blood samples in 178 patients from a prospective multinational study on cardiogenic shock. The association of hypoalbuminemia with clinical characteristics and course of hospital stay including treatment and procedures was assessed. The primary outcome was all-cause 90-day mortality. Results Hypoalbuminemia (P-Alb < 34g/L) was very frequent (75{\%}) at baseline in patients with cardiogenic shock. Patients with hypoalbuminemia had higher mortality than patients with normal albumin levels (48{\%} vs. 23{\%}, p = 0.004). Odds ratio for death at 90 days was 2.4 [95{\%} CI 1.5–4.1] per 10 g/L decrease in baseline P-Alb. The association with increased mortality remained independent in regression models adjusted for clinical risk scores developed for cardiogenic shock (CardShock score adjusted odds ratio 2.0 [95{\%} CI 1.1–3.8], IABP-SHOCK II score adjusted odds ratio 2.5 [95{\%}CI 1.2–5.0]) and variables associated with hypoalbuminemia at baseline (adjusted odds ratio 2.9 [95{\%}CI 1.2–7.1]). In serial measurements, albumin levels decreased at a similar rate between 0h and 72h in both survivors and nonsurvivors (ΔP-Alb -4.6 g/L vs. 5.4 g/L, p = 0.5). While the decrease was higher for patients with normal P-Alb at baseline (p<0.001 compared to patients with hypoalbuminemia at baseline), the rate of albumin decrease was not associated with outcome. Conclusions Hypoalbuminemia was a frequent finding early in cardiogenic shock, and P-Alb levels decreased during hospital stay. Low P-Alb at baseline was associated with mortality independently of other previously described risk factors. Thus, plasma albumin measurement should be part of the initial evaluation in patients with cardiogenic shock. Trial registration NCT01374867 at ClinicalTrials.gov.",
keywords = "SERUM-ALBUMIN CONCENTRATION, LEVELS PREDICT SURVIVAL, HEART-FAILURE, MYOCARDIAL-INFARCTION, PROGNOSTIC VALUE, RISK PREDICTION, ASSOCIATION, MANAGEMENT, ADMISSION, LEVEL, 3121 Internal medicine",
author = "{CardShock Investigators} and Toni J{\"a}ntti and Tuukka Tarvasm{\"a}ki and Veli-Pekka Harjola and John Parissis and Kari Pulkki and Tuija Javanainen and Heli Tolppanen and Raija Jurkko and Mari Hongisto and Anu Kataja and Alessandro Sionis and Jose Silva-Cardoso and Marek Banaszewski and Jindrich Spinar and Alexandre Mebazaa and Johan Lassus and Lars Kober and Johan Lassus and Alexandre Mebazaa and Marco Metra and John Parissis and Jose Silva-Cardoso and Alessandro Sionis and {Di Somma}, Salvatore and Jindrich Spinar and Katerina Koniari and Astrinos Voumvourakis and Apostolos Karavidas and Jordi Sans-Rosello and Montserrat Vila and Albert Duran-Cambra and Marco Metra and Michela Bulgari and Valentina Lazzarini and Jiri Parenica and Roman Stipal and Ondrej Ludka and Marie Palsuva and Eva Ganovska and Petr Kubena and Lindholm, {Matias G.} and Raija Jurkko and Kristiina Jarvinen and Tuomo Nieminen and Kari Pulkki and Leena Soininen and Reijo Sund and Ilkka Tierala and Jukka Tolonen and Marjut Varpula",
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CardShock Investigators, Jäntti, T, Tarvasmäki, T, Harjola, V-P, Parissis, J, Javanainen, T, Tolppanen, H, Jurkko, R, Hongisto, M, Kataja, A, Lassus, J, Jurkko, R, Jarvinen, K & Nieminen, T 2019, 'Hypoalbuminemia is a frequent marker of increased mortality in cardiogenic shock' PLoS One, vol. 14, no. 5, 0217006. https://doi.org/10.1371/journal.pone.0217006

Hypoalbuminemia is a frequent marker of increased mortality in cardiogenic shock. / CardShock Investigators ; Jäntti, Toni; Tarvasmäki, Tuukka; Harjola, Veli-Pekka; Parissis, John; Javanainen, Tuija; Tolppanen, Heli; Jurkko, Raija; Hongisto, Mari; Kataja, Anu; Lassus, Johan; Jurkko, Raija; Jarvinen, Kristiina; Nieminen, Tuomo.

In: PLoS One, Vol. 14, No. 5, 0217006, 16.05.2019.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Hypoalbuminemia is a frequent marker of increased mortality in cardiogenic shock

AU - CardShock Investigators

AU - Jäntti, Toni

AU - Tarvasmäki, Tuukka

AU - Harjola, Veli-Pekka

AU - Parissis, John

AU - Pulkki, Kari

AU - Javanainen, Tuija

AU - Tolppanen, Heli

AU - Jurkko, Raija

AU - Hongisto, Mari

AU - Kataja, Anu

AU - Sionis, Alessandro

AU - Silva-Cardoso, Jose

AU - Banaszewski, Marek

AU - Spinar, Jindrich

AU - Mebazaa, Alexandre

AU - Lassus, Johan

AU - Kober, Lars

AU - Lassus, Johan

AU - Mebazaa, Alexandre

AU - Metra, Marco

AU - Parissis, John

AU - Silva-Cardoso, Jose

AU - Sionis, Alessandro

AU - Di Somma, Salvatore

AU - Spinar, Jindrich

AU - Koniari, Katerina

AU - Voumvourakis, Astrinos

AU - Karavidas, Apostolos

AU - Sans-Rosello, Jordi

AU - Vila, Montserrat

AU - Duran-Cambra, Albert

AU - Metra, Marco

AU - Bulgari, Michela

AU - Lazzarini, Valentina

AU - Parenica, Jiri

AU - Stipal, Roman

AU - Ludka, Ondrej

AU - Palsuva, Marie

AU - Ganovska, Eva

AU - Kubena, Petr

AU - Lindholm, Matias G.

AU - Jurkko, Raija

AU - Jarvinen, Kristiina

AU - Nieminen, Tuomo

AU - Pulkki, Kari

AU - Soininen, Leena

AU - Sund, Reijo

AU - Tierala, Ilkka

AU - Tolonen, Jukka

AU - Varpula, Marjut

PY - 2019/5/16

Y1 - 2019/5/16

N2 - Introduction The prevalence of hypoalbuminemia, early changes of plasma albumin (P-Alb) levels, and their effects on mortality in cardiogenic shock are unknown. Materials and methods P-Alb was measured from serial blood samples in 178 patients from a prospective multinational study on cardiogenic shock. The association of hypoalbuminemia with clinical characteristics and course of hospital stay including treatment and procedures was assessed. The primary outcome was all-cause 90-day mortality. Results Hypoalbuminemia (P-Alb < 34g/L) was very frequent (75%) at baseline in patients with cardiogenic shock. Patients with hypoalbuminemia had higher mortality than patients with normal albumin levels (48% vs. 23%, p = 0.004). Odds ratio for death at 90 days was 2.4 [95% CI 1.5–4.1] per 10 g/L decrease in baseline P-Alb. The association with increased mortality remained independent in regression models adjusted for clinical risk scores developed for cardiogenic shock (CardShock score adjusted odds ratio 2.0 [95% CI 1.1–3.8], IABP-SHOCK II score adjusted odds ratio 2.5 [95%CI 1.2–5.0]) and variables associated with hypoalbuminemia at baseline (adjusted odds ratio 2.9 [95%CI 1.2–7.1]). In serial measurements, albumin levels decreased at a similar rate between 0h and 72h in both survivors and nonsurvivors (ΔP-Alb -4.6 g/L vs. 5.4 g/L, p = 0.5). While the decrease was higher for patients with normal P-Alb at baseline (p<0.001 compared to patients with hypoalbuminemia at baseline), the rate of albumin decrease was not associated with outcome. Conclusions Hypoalbuminemia was a frequent finding early in cardiogenic shock, and P-Alb levels decreased during hospital stay. Low P-Alb at baseline was associated with mortality independently of other previously described risk factors. Thus, plasma albumin measurement should be part of the initial evaluation in patients with cardiogenic shock. Trial registration NCT01374867 at ClinicalTrials.gov.

AB - Introduction The prevalence of hypoalbuminemia, early changes of plasma albumin (P-Alb) levels, and their effects on mortality in cardiogenic shock are unknown. Materials and methods P-Alb was measured from serial blood samples in 178 patients from a prospective multinational study on cardiogenic shock. The association of hypoalbuminemia with clinical characteristics and course of hospital stay including treatment and procedures was assessed. The primary outcome was all-cause 90-day mortality. Results Hypoalbuminemia (P-Alb < 34g/L) was very frequent (75%) at baseline in patients with cardiogenic shock. Patients with hypoalbuminemia had higher mortality than patients with normal albumin levels (48% vs. 23%, p = 0.004). Odds ratio for death at 90 days was 2.4 [95% CI 1.5–4.1] per 10 g/L decrease in baseline P-Alb. The association with increased mortality remained independent in regression models adjusted for clinical risk scores developed for cardiogenic shock (CardShock score adjusted odds ratio 2.0 [95% CI 1.1–3.8], IABP-SHOCK II score adjusted odds ratio 2.5 [95%CI 1.2–5.0]) and variables associated with hypoalbuminemia at baseline (adjusted odds ratio 2.9 [95%CI 1.2–7.1]). In serial measurements, albumin levels decreased at a similar rate between 0h and 72h in both survivors and nonsurvivors (ΔP-Alb -4.6 g/L vs. 5.4 g/L, p = 0.5). While the decrease was higher for patients with normal P-Alb at baseline (p<0.001 compared to patients with hypoalbuminemia at baseline), the rate of albumin decrease was not associated with outcome. Conclusions Hypoalbuminemia was a frequent finding early in cardiogenic shock, and P-Alb levels decreased during hospital stay. Low P-Alb at baseline was associated with mortality independently of other previously described risk factors. Thus, plasma albumin measurement should be part of the initial evaluation in patients with cardiogenic shock. Trial registration NCT01374867 at ClinicalTrials.gov.

KW - SERUM-ALBUMIN CONCENTRATION

KW - LEVELS PREDICT SURVIVAL

KW - HEART-FAILURE

KW - MYOCARDIAL-INFARCTION

KW - PROGNOSTIC VALUE

KW - RISK PREDICTION

KW - ASSOCIATION

KW - MANAGEMENT

KW - ADMISSION

KW - LEVEL

KW - 3121 Internal medicine

U2 - 10.1371/journal.pone.0217006

DO - 10.1371/journal.pone.0217006

M3 - Article

VL - 14

JO - PLoS One

JF - PLoS One

SN - 1932-6203

IS - 5

M1 - 0217006

ER -