Andrada Bogdan (Leviev Heart Centre, Sheba Medical Centre, Tel Hashomer, Israel) and others report in EuroIntervention that baseline albumin could be used as a “simple objective tool to assess frailty” as part of risk stratification in patients undergoing transcatheter aortic valve implantation (TAVI). They found that low baseline albumin (≤4g/dl) in TAVI patients was associated with a four-fold increase in all-cause mortality at one year and a two-fold increase in all-cause mortality at two years.
Bogdan et al comment that frailty is “an expression of vulnerability or susceptibility to disability and refers to a globally limited reserve to withstand stressors” and is associated with worse outcomes in patients undergoing interventions. However, they add, at present, current frailty scores—such as the Identification of Seniors at Risk (ISAR) score—used during risk stratification of patients being considered for TAVI are poorly correlated with outcomes, “especially long-term mortality”. Therefore, the authors say that “additional tools for simple pre-procedural assessment of TAVI candidates are needed”.
They note that a recent Valve Academic Research Consortium (VARC)-2 consensus document suggested that serum albumin could be used to assess frailty but the authors comment that there are “scarce data” available regarding baseline serum albumin as a marker of frailty in TAVI patients. Thus, the aim of their study was to evaluate the relationship between periprocedural levels of serum albumin and mortality in patients undergoing TAVI.
Of 150 consecutive patients who underwent TAVI at the authors’ centre (Sheba Medical Center, Tel Hashomer, Israel) between 2009 and 2012, 53% had a baseline serum albumin level of ≤4g/dl (low baseline albumin group) and 47% had a baseline serum albumin level of >4g/dl (normal baseline albumin group). Bogdan et al comment: “Notably, patients with low baseline albumin had significantly less dyslipidaemia but no significant differences were observed regarding other baseline characteristics.”
At one year, significantly more patients in the baseline albumin group had died compared with those in the normal baseline albumin group: 22.78% vs. 5.63% (p<0.01). The authors comment: “In the univariate analysis, a low baseline albumin was associated with a more than four-fold increase in all-cause mortality (P<0.01),” adding that a “strong correlation” between low baseline albumin and one-year, all-cause mortality was noted “even after adjustment for renal function” (p<0.01). Additionally, in a multivariate analysis of the two-year results, patients with low baseline albumin had a more than two-fold increase in 2.1-year mortality. “Furthermore, multivariate analysis showed that each 1g/dl increment in baseline albumin was independently associated with a significant 56% reduction in the risk of 2.1-year mortality (p=0.02),”Bogdan et al report.
The authors conclude: “Baseline serum albumin measurement may simplify the daily practice assessment of frailty in TAVI patients by offering the clinician a simple, objective, and rapid tool for predicting the survival benefit after the procedure.”
Bogdan told Cardiovascular News: “In older patients, a lower serum albumin level reflects a more frail status associated with decreased survival benefit following TAVI.”