Hypoalbuminemia and Lymphocytopenia in Patients With Decompensated Biventricular Failure

Abstract

BackgroundIn patients hospitalized with decompensated biventricular failure having hypoalbuminemia and lymphocytopenia without underlying hepatic or renal disease, we addressed the presence of a protein-losing enteropathy (PLE). MethodsWe studied 78 patients having a dilated cardiomyopathy, who were hospitalized with congestive heart failure (CHF) and hypoalbuminemia of uncertain origin. In the first 19 patients, we investigated the presence of PLE using Tc-Dex70 scintigraphy together with serum albumin 2 to 4weeks later when compensation had been restored. In the next 59 patients, presenting with reduced serum albumin and relative lymphocyte count at admission, these parameters were again monitored (2–4 weeks) later when symptoms and signs of CHF had resolved. ResultsPLE, documented by Tc-Dex70 scintigraphy, was found in 10 of 19 patients and whose hypoalbuminemia (2.7±0.1g/dL, mean±standard error of mean) were corrected (3.3±0.1g/dL; P<0.05) with the resolution of CHF, whereas in the 9 patients without a PLE, reduced baseline serum albumin (2.6±0.1g/dL) failed to improve on follow-up (2.6±0.2g/dL) in keeping with malnutrition. Relative lymphocyte count was reduced (14.6±1.5%) in patients with PLE but was normal (21.4±3.3%; P<0.05) in those without PLE. Serum albumin and relative lymphocyte count were each reduced at admission (2.8±0.1g/dL and 14.4±1.0%, respectively) in 59 patients and increased (P<0.05) to normal values (3.5±0.1g/dL and 24.9±1.0%) 2 to 4weeks after they were compensated. ConclusionsEnteral losses of albumin and lymphocytes account for the reversible hypoalbuminemia and lymphocytopenia found in patients hospitalized with CHF having splanchnic congestion.