Abstract 12725: Sarcopenia With Low Serum Albumin is Associated With Worse Prognosis in Patients Hospitalized for Acute Decompensated Heart Failure

Abstract

Introduction: Low serum albumin is a marker of protein malnutrition and is commonly associated with worse outcomes in various clinical settings. Furthermore, significant overlap exists between malnutrition and sarcopenia, which can be an independent predictor of worse outcomes. Hypothesis: We assessed the hypothesis that the presence of sarcopenia with low albumin (SLA) would lead to synergistically worse outcomes in patients with acute decompensated heart failure (ADHF). Methods: Patients hospitalized for ADHF from 2017 to 2019 with computed tomography of the abdomen/pelvis within 30 days and albumin level within 24 hours before discharge were studied (n=181). Given the high prevalence of hypoalbuminemia, low albumin was defined as the lower fiftieth percentile. Semi-automatic measurements of skeletal muscle area were made at L3 (Figure 1A) and adjusted using height squared to obtain skeletal muscle index (SMI). Sarcopenia was defined as the lowest sex-stratified SMI tertile. Results: The prevalence of sarcopenia alone was 11.6%, low albumin alone 28.7%, and SLA 20.4%. The groups had similar demographics but differed in BMI (lowest in sarcopenia alone, p<0.001) and admission NT-proBNP (highest in SLA, p=0.029). Patients with SLA were discharged to facilities most often (55.2%, p<0.001). All-cause mortality differed among the groups (p<0.001) during a median follow-up of 23.4 (4.2-45.0) months (Figure 1B). Compared to controls, those with SLA were at the highest risk (HR 2.46, 95%CI 1.50-4.02, p<0.001), followed by patients with low albumin alone (HR 1.77, 95%CI 1.11-2.83, p=0.016) or sarcopenia alone (HR 1.73, 95%CI 0.93-3.20, p=0.082), the latter not reaching significance. Conclusions: In conclusion, sarcopenia with low serum albumin is associated with higher mortality. Available resources and interventions should be utilized during ADHF hospitalization to optimize nutrition for these patients.