低白蛋白对老年慢性心力衰竭患者长期预后的影响

Prognostic Value of Hypoalbuminemia for Long-term Outcome in Elderly Patients with Chronic Heart Failure

目的通过倾向性评分分层分析法探讨低白蛋白对老年慢性心力衰竭患者长期预后的影响。方法连续入选1271例老年慢性心力衰竭患者,按血清白蛋白水平分为两组：白蛋白正常组（血清白蛋白≥35 g/L）、低白蛋白组（血清白蛋白〈35 g/L）。以全因死亡为主要终点,采用倾向性评分分层分析法,通过多因素COX回归分别评价分层前后低白蛋白对长期预后的影响。结果分层之前,与白蛋白正常组相比,低白蛋白组年龄更大,心功能纽约分级、直接胆红素、碱性磷酸酶、肌酐、脑钠肽更高,高血压更少,血红蛋白、间接胆红素、胆固醇、血钠、入院射血分数更低,入院心率更快。所有患者平均随访23.9个月,随访期间,整体死亡165人,病死率为13.0%;低白蛋白组死亡76人,病死率为46.1%;白蛋白正常组死亡260人,病死率为23.5%。单因素COX回归分析显示,低白蛋白是老年慢性心衰患者长期死亡风险增加的强独立预测因子（HR为2.540,95%CI为1.966~3.282,P〈0.001）;即使校正了倾向性评分值后,低白蛋白患者的长期死亡风险仍比白蛋白正常者显著增加了56.1%（HR为1.561,95%CI为1.186~2.054,P=0.001）。采用倾向性评分分层分析法后,合并的HR为1.724,95%CI为1.311~2.268,提示低白蛋白患者的长期死亡风险要比白蛋白正常者高0.724倍。结论对于老年慢性心力衰竭患者,低白蛋白预示着死亡风险的增加,纠正低白蛋白有可能改善心衰患者的预后。

Aim To analyze the prognostic value of hypoalbuminemia for long-term outcome in elderly patients with chronic heart failure after propensity score stratification. Methods 1271 consecutive elderly patients with chronic heart failure were enrolled and divided into two groups according to serum albumin concentration on admission 35 g / L（ hypoalbuminemia group） and ≥35 g/L（ normoalbuminemia group）. Propensity score stratification was conducted to reduce confounding bias. And then COX proportional-hazards regression modeling was used to evaluate the prognostic value of hypoalbuminemia for long-term outcome for the pre-stratification and post-stratification data. Results Before stratification,hypoalbuminemia group was older,had higher NYHA status,direct bilirubin,alkaline phosphatase,creatinine,BNP,less hypertension; lower hemoglobin,indirect bilirubin,TC,serum sodium on admission,EF on admission; faster heart rate on admission. During the median 23. 9-month follow-up,there were 165 deaths（ 13. 0%） for all causes,76 in hypoalbuminemia group（ 46. 1%）,260 in normoalbuminemia group（ 23. 5%）. The univariate COX regression analysis indicated that hypoalbuminemia was the strong independent risk for long-term mortality in elderly patients with chronic heart failure（ HR was 2. 540,95% CI was 1. 966 ~ 3. 282,P〈0. 001）. Adjusted for propensity score,the multivariate COX regression analysis indicated that the risk of long-term mortality in hypoalbuminemia patients increased 56. 1% than the normoalbuminemia patients（ HR was 1. 561,95% CI was 1. 186 ~ 2. 054,P = 0. 001）. After adjustment using propensity score stratification,the overall HR was 1. 724,95% CI was 1. 311 ~ 2. 268,which indicated that the risk of long-term mortality in hypoalbuminemia patients increased 0. 724-time than the normoalbuminemia patients. Conclusions Hypoalbuminemia indicated the increasing of long-term mortality in elderly patients with chronic heart failure. It was possible to improve the prognosis of elderly patients with chronic heart failure by correcting hypoalbuminemia.