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Low Muscle Mass, Hypoalbuminemia Increase Mortality Risk in ADHF


Patients admitted to the hospital with acute decompensated heart failure (ADHF) who also had low muscle mass and hypoalbuminemia experienced a heightened mortality risk, suggesting skeletal muscle mass and serum albumin are important prognostic factors.

A study published in the Journal of the American Heart Association found patients hospitalized with acute decompensated heart failure (ADHF) as well as low muscle mass (LMM) and hypoalbuminemia to be at higher risks of adverse in-hospital outcomes and postdischarge mortality compared with patients without the combination of comorbidities.

Patient in the hospital | Image credit: Tyler Olson -stock.adobe.com

Patient in the hospital | Image credit: Tyler Olson -stock.adobe.com

In ADHF, sarcopenia and hypoalbuminemia have both been found to be independent prognostic factors for adverse outcomes such as mortality and hospital readmission. However, their impact when they occur together has not been explored. Authors of the study therefore aimed to determine the combined prognostic value of lower muscle mass (LMM)—a surrogate for sarcopenia—and hypoalbuminemia in patients hospitalized with ADHF.

The retrospective study included 385 patients who were admitted to the hospital for ADHF between 2017 and 2020 at a single institution. Data on serum albumin levels were collected at admission and discharge, and skeletal muscle categorizations were determined by semi-automated segmentation software analysis on axial chest CT scans.

In the overall cohort, 27.9% of patients had higher muscle mass without discharge hypoalbuminemia, with this group used as a reference cohort; 9.7% had LMM without hypoalbuminemia at discharge; 38.4% had higher muscle mass with hypoalbuminemia at discharge; and 24.0% had LMM with hypoalbuminemia at discharge.

Patients who had both LMM and hypoalbuminemia were more likely to be diagnosed with infection and delirium (15.9% vs ≤6.6%), had longer lengths of stay (median 9 days vs ≤7 days), and were more frequently discharged to facilities (42.6% vs ≤29.5%) compared with patients in the other 3 cohorts.

The mortality rate was also highest (63.2%) in the group with both LMM and hypoalbuminemia, followed by those with LMM without hypoalbuminemia (51.4%), patients with higher muscle mass with hypoalbuminemia (48.9%), and the reference cohort (37.6%). Patients with LMM and hypoalbuminemia at discharge also had the highest 1- and 3-year mortality risks, and adjusted multivariate analysis found the relationship significant at a median 23.6 months of follow-up (HR, 2.03; 95% CI, 1.31-3.16; P = .002).

“A novel finding of the present study involves greater rates of adverse complications and mortality experienced by patients with ADHF with coexisting LMM and discharge hypoalbuminemia compared with patients without this combination,” the authors wrote. “Previous investigations studying the synergistic impact of sarcopenia and hypoalbuminemia on clinical outcomes have largely been conducted for other clinical applications, yet they report similar findings.”

Still, the mechanisms behind the findings have not been fully explained, although the authors noted that hypoalbuminemia and sarcopenia are associated with each other, as well as with advanced age and chronic diseases.

“LMM and hypoalbuminemia are associated with worse in-hospital and postdischarge outcomes in hospitalized patients with ADHF, and these adverse effects are compounded when they coexist,” the authors concluded. “Therefore, patients with ADHF with LMM and albumin must be identified early for aggressive nutritional and physical rehabilitation interventions. There is an urgent need for prospective investigations assessing this relationship so that its mechanism can be further investigated and targeted treatments may be developed.”


Mirzai S, Sarnaik KS, Persits I, et al. Combined prognostic impact of low muscle mass and hypoalbuminemia in patients hospitalized for heart failure: a retrospective cohort study. J Am Heart Assoc. Published online January 23, 2024. doi:10.1161/JAHA.123.030991

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