Prognostic value of the albumin-bilirubin score in critically ill patients with heart failure

Background: This study sought to examine the association between the albumin-bilirubin (ALBI) score and short-term and 4-year all-cause mortality in critically ill patients with heart failure (HF), and to build a simple and effective new predictive model.

Methods: The Monitoring in Intensive Care Database III was used to identify patients with HF who had been admitted to the intensive care unit (ICU) from 2001 to 2012. Correlations between ALBI scores and other commonly used risk-scoring methods and short-term and 4-year all-cause mortality were examined using the Kaplan-Meier method and Cox proportional hazards-regression models.

Results: The data of 3,381 ICU patients were included in the study, of whom 53.7% were male. The patients had a mean age of 70.02±12.55 years, and a short-term mortality rate of 27.7%. The ALBI score of survivors [-1.80 (-2.09 to -1.44)] was significantly lower than that of non-survivors [-1.43 (-1.80 to -0.99)] (P<0.001), and independently predicted short-term all-cause mortality and higher 4-year mortality. The area under the receiver operating characteristic curve (AUC) of the ALBI score for short-term mortality was 0.676, and that of the Get With the Guidelines-Heart Failure (GWTG-HF) score was 0.643. The new model, which combined the ALBI and GWTG-HF (the GWTG-HF-ALBI), had an AUC of 0.713. The AUC of the ALBI score for predicting 4-year all-cause mortality was 0.596, that of the GWTG-HF score was 0.638, and that of the GWTG-HF-ALBI risk score was 0.650.

Conclusions: The ALBI score is useful at predicting the mortality of patients with HF requiring ICU admission. The GWTG-HF-ALBI model is simpler to use than other models that contain subjective items, such as the Glasgow Coma Score, and can be used to predict the short-term and 4-year all-cause mortality of these patients.