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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

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

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.

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aSchool of Medicine

bDepartment of Medicine, San Francisco VA Medical Center

cDepartment of Epidemiology and Biostatistics, University of California, San Francisco

dSchool of Public Health, University of California, Berkeley, California, USA.

Correspondence to Michael G. Shlipak, MD, MPH, San Francisco Veterans Affairs Medical Center, 4150 Clement Street, Box 111A1, San Francisco, CA 94121, USA. Tel: +1 415 750 2093; e-mail:

Received 26 October, 2012

Revised 17 December, 2012

Accepted 17 January, 2013

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© 2013 Lippincott Williams & Wilkins, Inc.