血清白蛋白对射血分数保留的心力衰竭患者预后的影响

Association between serum albumin level and prognosis in heart failure patients with preserved ejection fraction

目的通过心力衰竭(heart failure,HF)队列研究分析血清白蛋白与射血分数保留的心力衰竭(heart failure with preserved ejection fraction,HFpEF)患者的预后关系。方法连续收集2017年7月—2018年12月在同济大学附属第十人民医院住院的HF患者的一般人口学特征、伴随疾病、实验室检查、心脏彩超检查、药物治疗情况等资料(源于GREATWAL研究,编号:NCT04062500)。排除其他类型HF等情况后,最终纳入317例HFpEF患者。根据血清白蛋白的中位数把HFpEF患者分为低白蛋白组(<40 g/L)和正常白蛋白组(≥40 g/L),并比较了两组之间的临床特征差异。此外通过K-M生存曲线和Cox回归模型评估血清白蛋白对HFpEF患者全因死亡率的影响。结果Spearman相关分析显示,血清白蛋白和C-反应蛋白负相关(r s=-0.242,P<0.001),与丙氨酸转氨酶、天冬氨酸转氨酶、血尿素氮、血肌酐无关(P>0.05)。在K-M生存曲线分析中,两组间差异有统计学意义(log-rank检验,P=0.011)。在单因素Cox回归分析中,低白蛋白分组的HFpEF患者的全因死亡风险比为2.255(95%CI:1.183~4.301,P=0.014)。在多因素Cox回归分析中,低白蛋白分组的HFpEF患者全因死亡风险比为2.095(95%CI:1.098~3.998,P=0.025)。结论血清白蛋白可能是HFpEF患者全因死亡的独立预测因素。

Objective To investigate the association between serum albumin level on prognosis of heart failure patients with preserved ejection fraction(HFpEF).Methods The demographic characteristics,concomitant diseases,laboratory tests,cardiac ultrasonography,and drug treatment of 672 patients with heart failure admitted to Shanghai Tenth People's Hospital from July 2017 to December 2018(GREATWAL study,NCT04062500)were collected,and 317 patients with HFpEF were finally included in the study.According to the median of serum albumin,patients were divided into low albumin group(<40 g/L)and normal albumin group(≥40 g/L),and the clinical characteristics between two groups were examined.Kaplan-Meier(K-M)survival curve and Cox regression model were used to assess the association between serum albumin levels and all-cause mortality in patients with HFpEF.Results Spearman correlation analysis showed that serum albumin was negatively correlated with C-reactive protein(r s=-0.242,P<0.001),but not correlated with alanine aminotransferase,aspartate aminotransferase,blood urea nitrogen and serum creatinine(P>0.05).K-M survival curve showed that there was significant difference in survival of patients between the two groups(log-rank test P=0.011).Univariate Cox regression analysis,showed that the all-cause hazard ratio for patients with HFpEF in the low albumin group was 2.255(95%CI:1.183-4.301,P=0.014).Multivariate Cox regression analysis showed that the all-cause hazard ratio for patients with HFpEF in the low albumin group was 2.095(95%CI:1.098-3.998,P=0.025).Conclusion Serum albumin may be an independent predictive factor for all-cause death in patients with HFpEF.