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Serum Albumin and Short-Term Risk for Mortality and Cardiovascular Disease among HIV-Infected Veterans.


AIDS. 2013 Jan 22;


Authors: Lang J, Scherzer R, Weekley CC, Tien PC, Grunfeld C, Shlipak MG


Abstract

OBJECTIVE:: We examined the short-term and long-term associations of serum albumin with mortality and cardiovascular disease among HIV-infected veterans. DESIGN:: Retrospective cohort analysis using a national database of U.S. veterans with HIV infection. METHODS:: This analysis evaluated all HIV-infected veterans in the Department of Veterans Affairs HIV Clinical Case Registry (CCR), a national database comprised of demographic, clinical, laboratory, pharmaceutical, and viral status data. There were 25 522 patients enrolled between 1986 and 2007. We evaluated the associations of baseline and time-updated serum albumin levels with all-cause mortality, atherosclerotic cardiovascular disease, and heart failure by multivariate proportional hazards models. RESULTS:: Over 21 years, there were 10 869 deaths; the cumulative mortality was 73.2 per 1000 person-years. After multivariate adjustment for covariates measured at baseline, the lowest category of serum albumin (<2.5 g/L) was associated with a higher mortality risk compared with the highest category (>4 g/L) (Hazard Ratio 3.00; 2.67-3.37). However, when analyzed as a time-dependent model, the association strengthened substantially (15.1; 14.0-16.4). Findings were similar for atherosclerotic cardiovascular disease and heart failure. We stratified the baseline mortality model by year of follow up and found that albumin was more strongly associated with deaths that occurred within one year of baseline (9.29; 7.85-11.0) than in the second (1.66; 1.18-2.33) or third (1.22; 0.77-1.96) year after measurement. CONCLUSIONS:: Among ambulatory HIV-infected patients, lower serum albumin levels are strongly predictive of mortality risk, particularly within one year.

PMID: 23343914 [PubMed - as supplied by publisher]