Albumin-Bilirubin Score: A Novel Mortality Predictor in Valvular Surgery

Duman, Zihni Mert; Timur, Barış

doi:10.21470/1678-9741-2022-0008

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Brazilian Journal of Cardiovascular Surgery

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ORIGINAL ARTICLE • Braz. J. Cardiovasc. Surg. 38 (02) • 2023 • https://doi.org/10.21470/1678-9741-2022-0008 copy

Albumin-Bilirubin Score: A Novel Mortality Predictor in Valvular Surgery

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Introduction:

The heart and liver are two organs that are closely related. The Albumin-Bilirubin (ALBI) score is a developed scoring system for assessing liver function. The aims of this study were to examine the correlation between preoperative ALBI score and pulmonary artery pressure and to investigate its ability to predict heart valve surgery mortality outcomes.

Methods:

The data of 872 patients who underwent isolated and combined heart valve surgery from 2014 to 2021 were retrospectively screened. In the preoperative period, 152 patients with laboratory tests including albumin and total bilirubin were found and analyzed retrospectively. Thirteen of these patients were excluded from the study. The remaining 139 patients were included in the analysis. Baseline demographic data, echocardiography data, performance status, laboratory data, operative data, and postoperative status were collected. The optimal cutoff value of preoperative ALBI score was calculated.

Results:

The cutoff for ALBI scores was calculated as -2.44 to predict in-hospital mortality (sensitivity = 75.0%, specificity = 70%). Based on the cutoff value, 90 patients had a low ALBI score (≤ -2.44, 64.7%) and 49 patients had a high ALBI score (> -2.44, 35.3%). High ALBI score was associated with an increased incidence of acute kidney injury and in-hospital mortality, and a positive correlation was found between ALBI score and pulmonary artery pressure.

Conclusion:

In patients with valvular surgery, high ALBI score was an independent prognostic factor of in-hospital mortality and acute kidney injury. It is easily measurable and a cost-effective way to predict mortality.

Keywords:
Heart Valve; Acute Kidney Injury; Albumins; Aptitude; Echocardiography; Hospital Mortality; Preoperative Period.

Abbreviations, Acronyms & Symbols
AF	= Atrial fibrillation	EuroSCORE	= European System for Cardiac Operative Risk Evaluation
AKI	= Acute kidney injury	Hba1c	= Glycosylated hemoglobin
ALBI	= Albumin-Bilirubin	Hgb	= Hemoglobin
ALT	= Alanine aminotransferase	IABP	= Intra-aortic balloon pump
APTT	= Activated partial thromboplastin time	ICU	= Intensive care unit
AST	= Aspartate aminotransferase	INR	= International normalized ratio
AUC	= Area under the ROC curve	LVEF	= Left ventricular ejection fraction
BUN	= Blood urea nitrogen	MELD	= Model for End-Stage Liver Disease
CC	= Cross-clamping	NYHA	= New York Heart Association
CI	= Confidence interval	OR	= Odds ratio
COPD	= Chronic obstructive pulmonary disease	PAP	= Pulmonary artery pressure
CPB	= Cardiopulmonary bypass	PLT	= Platelet
CRE	= Creatinine	ROC	= Receiver operating characteristic
DM	= Diabetes mellitus	WBC	= White blood cell
ECMO	= Extracorporeal membrane oxygenation

Type of surgery	N (%)
Isolated aortic valve surgery	15 (10.8%)
Isolated mitral valve surgery	38 (27.3%)
Combined mitral and tricuspid valve surgery	50 (36%)
Combined aortic and mitral valve surgery	20 (14.4%)
Combined aortic, mitral, and tricuspid valve surgery	16 (11.5%)
Reoperation	15 (10.8%)

	ALBI score < -2.44 (n=90) N (%) or mean±standard deviation	ALBI score >-2.44 (n=49) N (%) or mean±standard deviation	P-value
Age (years)	55.32±12.665	56.12±12.360	0.805
Sex (female)	54 (60%)	24 (48.9%)	0.211
NYHA class 3-4	36 (40%)	29 (59.1%)	0.00^*
Preoperative atrial fibrillation	22 (24.4%)	18 (36.7%)	0.148
Infective endocarditis	6 (6.6%)	11 (22.4%)	0.007^*
LVEF	54.77±9.44	55.20±9.62	0.727
PAP	40.91±17.31	48.86±19.66	0.011^*
EuroSCORE II	2.40±1.88	4.22±5.11	0.037^*
Reoperation	8 (9%)	7 (14%)	0.327
DM	22 (24.4%)	9 (18.3%)	0.411
Renal failure	13 (14.4%)	9 (18.3%)	0.545
COPD	22 (24.4%)	12 (24.5%)	0.995
Preoperative laboratory values
WBC (109/L)	8.08±1.99	9.63±3.48	0.244
Hgb	19.51±11.42	17.10±11.28	0.313
PLT	236.88±63.87	279.08±57.55	0.090
ALT (U/L)	22.33±15.57	30.04±29.96	0.226
AST (U/L)	24.11±13.27	35.33±36.482	0.143
BUN	20.32±8.95	26.46±19.721	0.159
CRE	1.16±1.87	1.20±1.76	0.502
Hba1c	5.95±1.65	5.81±1.31	0.761
APTT (s)	29.88±6.46	30.16±5.71	0.301
INR	1.32±0.74	1.41±0.59	0.048^*

	ALBI score < -2.44 (n=90) N (%) or mean±standard deviation	ALBI score > -2.44 (n=49) N (%) or mean±standard deviation	P-value
CC time	90.59±36.180	96.04±36.487	0.371
CPB time	134.28±48.12	147.94±65.219	0.406
Re-exploration for bleeding	17 (18.9%)	5 (10.2%)	0.180

	Univariable analyses			Multivariable analyses
	OR	95% CI	P-value	OR	95% CI	P-value
ALBI score	3.83	1.55 - 9.49	0.004^*	3.37	1.09 - 10.5	0.036^*
EuroSCORE II	1.25	1.09 - 1.44	0.002^*	1.09	0.92 - 1.29	0.331
Age (years)	1.05	0.99 - 1.1	0.077
NYHA class 3-4	4.51	1.38 - 14.86	0.013^*	3.14	0.71 - 14.5	0.134
LVEF	0.98	0.93 - 1.04	0.542
PAP	1.02	0.99 - 1.05	0.187
DM	1.18	0.35 - 3.97	0.783
Renal failure	2.83	0.87 - 9.17	0.082
CPB time	1.02	1.01 - 1.03	< 0.001^*	1.02	1.01 - 1.03	0.001^*
Combined aortic, mitral, and tricuspid valve surgery	6.78	2.04 - 22.5	0.002^*	1.23	0.31 - 6.99	0.851
Infective endocarditis surgery	2.82	0.79 - 10.1	0.109
Reoperation	2.20	0.75 - 3.92	0.115

	ALBI score < -2.44 (n=90) N (%) or mean±standard deviation	ALBI score > -2.44 (n=49) N (%) or mean±standard deviation	P-value
Hospital mortality	4 (4.4%)	12 (24.5%)	< 0.001^*
Ventilation time (days)	2.23±453	5.16±8.27	0.214
ICU stay (days)	3.89±7.93	7.31±11.46	0.234
Hospital stay (days)	11.83±9.75	15.14±16.38	0.667
Temporary pacemaker requirement	14 (15.6%)	7 (14.2%)	0.842
Permanent pacemaker requirement	8 (8.8%)	3 (6.1%)	0.564
AKI	19 (21.1%)	19 (38.8%)	0.028^*
Wound complication	10 (11.1%)	6 (12.2%)	0.841
ECMO	0 (0%)	2 (4.1%)	0.054
IABP	3 (3.3%)	2 (4.1%)	0.821
Postoperative AF	16 (17.8%)	9 (18.4%)	0.931

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E-mail: bjcvs@sbccv.org.br

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[1] *
Both authors were working at Mehmet Akif Ersoy Hospital when the study was conducted.