Association of Low Serum Albumin Levels and its In-hospital Adverse Outcomes among Patients Presenting with Acute Coronary Syndrome in a Tertiary Care Hospital of West Bengal, India

Introduction: Acute Coronary Syndrome (ACS) is characterised by hypercoagulability and inflammation. In acute presentation of Ischaemic Heart Disease (IHD), like ACS, serum albumin may also play an important role. Many patients with ischaemic cerebrovascular accident, a condition similar to ACS, had low serum albumin.

Aim: To estimate serum albumin levels in patient with ACS and its relation to hospital adverse outcome.

Materials and Methods: The present prospective observational study was conducted in the Department of General Medicine at R.G. Kar Medical College and Hospital, West Bengal, India. The duration of the study was 18 months, from July 2019 to October 2020. Patients with ACS were included irrespective of age, sex, race and predisposing factors such as Hypertension (HTN), Diabetes Mellitus (DM), hyperthyroidism and dyslipidaemia. A total of 125 patients included and details such as relevant history, examination findings, laboratory investigation, Electrocardiography (ECG), Echocardiography (ECHO), chest X-ray Posteroanterior (PA) view were included. Chi-square test and logistic regression were applied.

Results: A total of 94 (75.2%) patients were males. 49 (39.2%) study patients had DM. Total 10 (8%) patients presented with cardiac arrest at admission. In-hospital death was happened in 9 (7.2%) cases. 59 (47.2%) patients had normal serum albumin level (3.5-4.5). 61 (48.8%) had mild to moderate hypoalbuminaemia (2.5-3.5) and only 5 (4%) had severe hypoalbuminaemia (<2.5). Association of in-hospital complication vs serum albumin level was statistically significant (p<0.0001). A multivariate logistic regression analysis showed that male gender (p-value=0.026), smoking (p-value=0.008), arrhythmia (p-value=0.002), increased creatinine (p-value=0.032) and hypoalbuminaemia (p<0.001) were statistically significant independent predictors of in-hospital adverse outcomes.

Conclusion: The low serum albumin level, measured immediately on hospital admission in ACS patients was associated with in-hospital complications, and when adjusted for other covariates, hypoalbuminaemia predicts in-hospital adverse outcome independently.