Impact of Albumin-bilirubin (ALBI) score on the Prognostic Significance of Patients with Heart Failure:A Retrospective Cohort Study

Abstract Objectives Liver dysfunction is prevalent in heart failure (HF) patients and it can bring a poor prognosis. Presently, albumin-bilirubin (ALBI) score has been designed as an effective and convenient scoring system for assessing liver function, but the correlation linking ALBI and in-hospital mortality in HF patients remains unclear.Methods and Results A total of 9749 patients with HF (from January 2013 to December 2018) was enrolled and retrospectively analyzed.
The main outcome is in-hospital death. We examined and analyzed ALBI as a continuous variable as well as according to 3 categories. Following adjustment for multivariable, patients which occurred in-hospital death was remarkably elevated in Tertile 3 group (ALBI>-2.27) (OR=1.670, 95% CI: 1.231~2.265, p=0.001), relative to the other two groups (Tertile 1: <-2.59; Tertile 2: -2.59~-2.27). When ALBI was inspected as a continuous variable, the incidence of HF patients with in-hospital death will increase by 8.2%. (For ALBI score per 0.1 score increasing, OR=1.082, 95% CI: 1.052~1.113, p<0.001). ALBI score for estimating in-hospital mortality under C-statistic was 0.650 (95% CI: 0.641~0.660, p<0.001) and the cut-off value of ALBI score was -2.32 with a specificity of 0.630 and a sensitivity of 0.632. Moreover, ALBI score can enhance the estimation potential of NT-proBNP (NT-proBNP+ALBI vs NT-proBNP: C-statistic: z=1.990, p=0.0467; net reclassification improvement=0.4012, p<0.001; integrated discrimination improvement= 0.0082, p<0.001). Conclusions In patients with HF, ALBI score was an independent prognosticator of in-hospital death. The predictive significance of NT-proBNP +ALBI was superior to NT-proBNP, and ALBI score can enhance the estimation potential of NT-proBNP.