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AIDS:
doi: 10.1097/QAD.0b013e32835f1dd6
Epidemiology and Social: CONCISE COMMUNICATION

Serum albumin and short-term risk for mortality and cardiovascular disease among HIV-infected veterans

Lang, Joshuaa; Scherzer, Rebeccab,c; Weekley, Cristin C.d; Tien, Phyllis C.b,c; Grunfeld, Carlb,c; Shlipak, Michael G.b,c

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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 US 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 consisting 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/dl) was associated with a higher mortality risk compared with the highest category (>4 g/dl; hazard ratio 3.00; 2.67–3.37). 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 1 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.

Conclusion: Among ambulatory HIV-infected patients, lower serum albumin levels are strongly predictive of mortality risk, particularly within 1 year.

© 2013 Lippincott Williams & Wilkins, Inc.

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