The impact of hypoalbuminemia on the long-term prognosis of patients with acute heart failure: The modifying role of carbohydrate antigen 125

Aims: Hypoalbuminemia is frequently found in patients with heart failure (HF), associated with higher morbimortality in acute HF (AHF). Moreover, Carbohydrate Antigen 125 (CA125) is elevated in most of the AHF patients. In this cohort of patients admitted for AHF, our objective was to evaluate the association between hypoalbuminemia and long-term outcomes, including mortality and HF readmissions, stratified by CA125 concentration.

Methods and results: This is a retrospective observational study involving a derivation and a validation cohort of patients, included 1225 and 428 patients respectively, both cohorts of patients admitted for AHF, in two different hospitals. A variable with 4 categories was formed by combining albumin and CA125. The combined of 1-year all-cause mortality and unplanned HF rehospitalizations were selected as the main endpoints. Analysis was carried out by a Cox proportional hazard regression and p-value for interaction. The median (IQR) age was 77 (63-82) years, 514 (41.7 %) were women, 620 (50.2 %) had a preserved left ventricular ejection fraction. In the derivation cohort, after multivariate adjustment, the differential association of hypoalbuminemia according CA125 persisted significantly (p-value for interaction=0.036). Patients with hypoalbuminemia and CA125>35 U/ml confirmed identifying a subgroup at higher risk (HR: 1.35, CI 95 %=1.10-1.69, p = 0.009). Similar results were obtained in the validation cohort.

Conclusion: In patients with AHF, the prognostic impact of albumin is influenced by CA125 levels. Hypoalbuminemia was associated with higher risk of death or HF readmission only when coexisted with high CA125. On the contrary, when CA125 was low, hypoalbuminemia lacked prognostic effect.