The effect of serum albumin levels before IMPELLA insertion on mortality risk in patients with cardiogenic shock.

Abstract

Despite advances in the treatment of cardiogenic shock (CS), the 30-day mortality rate remains high. While some biomarkers predict outcomes in CS, none have been identified for prognostic prediction in IMPELLA patients. Patients with IMPELLA support due to CS were prospectively enrolled in the Japanese Registry for Percutaneous Ventricular Assist Devices. Patients enrolled between February 2020 and December 2022 were included in the study cohort. We investigated the effects of albumin levels before IMPELLA insertion. The primary endpoint was all-cause mortality within 30 days following IMPELLA initiation. A total of 3,683 patients diagnosed with CS (median age, 69 years; 77.3% male) were included in our analysis. Acute coronary syndromes were present in 1,920 (52.1%) of the patients, whereas out-of-hospital cardiac arrest had occurred in 856 of the patients (23.2%). Before IMPELLA insertion, 1,727 (46.9%) of the patients received venoarterial extracorporeal membrane oxygenation. ROC curve showed that a cut-off albumin level of 3.5 g/dL predicted the 30-day survival rate with a sensitivity of 0.613 and a specificity of 0.507. Patients with albumin levels of ≥ 3.5 g/dL had a significantly higher 30-day survival rate (67% vs. 57%; hazard ratio = 0.736; 95% confidence interval: 0.6785-0.7894; p < 0.01). Lower baseline serum albumin levels were associated with worse outcomes in patients with CS receiving IMPELLA support.