Albumin-Bilirubin Score for Prediction of Outcomes in Heart Failure Patients Treated with Cardiac Resynchronization Therapy

Abstract

Background: Liver function may be a useful indicator of response to cardiac resynchronization therapy (CRT). We aimed to investigate the clinical significance of albumin-bilirubin (ALBI) score, an assessment tool of liver function, on outcomes in heart failure (HF) patients treated with CRT. Methods: We studied 180 patients undergoing CRT. The ALBI score, derived from albumin and total bilirubin, and left ventricular ejection fraction (LVEF) were assessed before and 6 months after CRT. The patients were classified according to the ALBI score before CRT; High (>−2.60) or Low (≤−2.60) ALBI groups. The patients were then reclassified based on the ALBI score before and 6 months after CRT; High/High, High/Low, Low/High, and Low/Low ALBI groups. We evaluated the prognostic value of the ALBI score for HF deaths after CRT. Results: During a median follow-up period of 50 months, there were 41 (22.7%) HF deaths. A Cox proportional hazard analysis revealed that high ALBI scores at baseline were not related to HF deaths (hazard ratio, 1.907, p = 0.068). However, High/High ALBI scores, but not High/Low or Low/High ALBI scores, were an independent predictor of HF deaths compared with Low/Low ALBI scores (hazard ratio, 3.449, p = 0.008), implying that consistently high ALBI scores were associated with poor prognosis. The percentage change in LVEF from baseline to 6 months after CRT did not differ among the four groups, suggesting that left ventricular systolic function was not linked with the ALBI score. Conclusions: ALBI scores before and after CRT are a new indicator of CRT response, and have a predictive value for HF deaths in HF patients.