Background
Although liver dysfunction is one of the common complications in patients with acute
heart failure (AHF), no integrated marker has been defined. The albumin-bilirubin
(ALBI) score has recently been proposed as a novel, clinically-applicable scoring
system for liver dysfunction. We investigated the utility of the ALBI score in patients
with AHF compared to that for a preexisting liver dysfunction score, the Model of
End-Stage Liver Disease Excluding prothrombin time (MELD XI) score.
Methods
We evaluated ALBI and MELD XI scores in 1,190 AHF patients enrolled in the prospective,
multicentre Registry Focused on Very Early Presentation and Treatment in Emergency
Department of Acute Heart Failure study. The associations between the two scores and
the clinical profile and prognostic predictive ability for 1-year mortality were evaluated.
Results
The mean MELD XI and ALBI scores were 13.4±4.8 and -2.25±0.48, respectively. A higher
ALBI score, but not higher MELD XI score, was associated with findings of fluid overload.
After adjusting for pre-existing prognostic factors, the ALBI score (HR 2.11, 95%
CI: 1.60–2.79, p<0.001), but not the MELD XI score (HR 1.02, 95% CI: 0.99–1.06, p=0.242),
was associated with 1-year mortality. Likewise, area under the receiver-operator-characteristic
curves for 1-year mortality significantly increased when the ALBI score (0.71 vs.
0.74, p=0.020), but not the MELD XI score (0.71 vs. 0.72, p=0.448), was added to the
pre-existing risk factors.
Conclusions
The ALBI score is potentially a suitable liver dysfunction marker that incorporates
information on fluid overload and prognosis in patients with AHF. These results provide
new insights into heart-liver interactions in AHF patients.
Keywords
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Article info
Publication history
Published online: December 18, 2019
Accepted:
December 1,
2019
Received in revised form:
October 7,
2019
Received:
March 20,
2019
Identification
Copyright
© 2019 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
