Predictive Role of the ALBI Score in Short- and Long-Term Mortality Among Patients Presenting to the Emergency Department With Infective Endocarditis

Öz

Objective: This study aimed to evaluate the predictive power of the Albumin–Bilirubin (ALBI) score for short-term and long-term mortality in patients presenting to the emergency department (ED) with infective endocarditis (IE). Material and Method: In this retrospective study, 104 adult IE patients were included. Patients were categorized into low-risk (≤ -2.6) and high-risk (> -2.6) groups based on their ALBI scores. Survival was assessed using Kaplan–Meier and multivariate Cox regression analyses. Results: The 30-day mortality rate was 24.3% in the high ALBI group compared to 2.9% in the low ALBI group ($p=0.001$). Cox regression analysis revealed that each 1-SD increase in the ALBI score was an independent predictor of long-term mortality (HR 1.77, 95% CI 1.40–2.24). Conclusion: The ALBI score is a practical, independent marker based on routine laboratory data that strongly predicts both short- and long-term survival for risk stratification of IE patients in the ED.

Anahtar Kelimeler

• Infective endocarditis
• Albumin–bilirubin (ALBI) score
• Mortality
• Emergency department
• Risk stratification

Acil Servise Başvuran Enfektif Endokardit Hastalarında ALBI Skorunun Kısa ve Uzun Dönem Mortaliteyi Öngörmedeki Rolü

Öz

Amaç: Bu çalışma, acil servise başvuran enfektif endokardit (EE) hastalarında Albumin–Bilirubin (ALBI) skorunun kısa ve uzun dönem mortaliteyi öngördürücü gücünü değerlendirmeyi hedeflemiştir. Gereç ve Yöntem: Retrospektif çalışmaya 104 erişkin EE hastası dahil edilmiştir. Hastalar ALBI skoruna göre düşük (≤ -2.6) ve yüksek (> -2.6) riskli olarak iki gruba ayrılmış; sağkalım analizleri Kaplan-Meier ve Cox regresyon yöntemleriyle yapılmıştır. Bulgular: Yüksek ALBI grubunda 30 günlük mortalite %24.3 iken, düşük grupta %2.9 olarak saptanmıştır ($p=0.001$). Cox regresyon analizi, ALBI skorundaki her 1 standart sapmalık artışın uzun dönem mortalite riskini 1.77 kat artırdığını (HR 1.77) ortaya koymuştur. Sonuç: ALBI skoru, acil serviste EE hastalarının risk sınıflamasında pratik, rutin laboratuvar verilerine dayanan ve hem kısa hem uzun dönem sağkalımı güçlü şekilde öngören bağımsız bir belirteçtir.

Anahtar Kelimeler

• Enfektif endokardit
• Albumin–bilirubin (ALBI) skoru
• Mortalite
• Acil Servis
• Risk sınıflaması

Kaynakça

1. Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta J-P, Del Zotti F, Dulgheru R, El Khoury G, Erba PA, Iung B, et al. 2015 ESC Guidelines for the management of infective endocarditis. Eur Heart J. 2015;36:3075–3128. doi: 10.1093/eurheartj/ehv319.
2. Baddour LM, Wilson WR, Bayer AS, Fowler VG, Tleyjeh IM, Rybak MJ, Barsic B, Lockhart PB, Gewitz MH, Levison ME, et al. Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications. Circulation. 2015;132:1435–1486. doi: 10.1161/CIR.0000000000000296.
3. Johnson PJ, Berhane S, Kagebayashi C, Satomura S, Teng M, Reeves HL, O’Beirne J, Fox R, Skowronska A, Palmer D, et al. Assessment of Liver Function in Patients With Hepatocellular Carcinoma: A New Evidence-Based Approach—The ALBI Grade. Journal of Clinical Oncology. 2015;33:550–558. doi: 10.1200/JCO.2014.57.9151.
4. Hiraoka A, Kumada T, Kudo M, Hirooka M, Tsuji K, Itobayashi E, Kariyama K, Ishikawa T, Tajiri K, Ochi H, et al. Albumin-Bilirubin (ALBI) Grade as Part of the Evidence-Based Clinical Practice Guideline for HCC of the Japan Society of Hepatology: A Comparison with the Liver Damage and Child-Pugh Classifications. Liver Cancer. 2017;6:204–215. doi: 10.1159/000452846.
5. Peng Y, Wei Q, He Y, Xie Q, Liang Y, Zhang L, Xia Y, Li Y, Chen W, Zhao J, et al. ALBI versus child-pugh in predicting outcome of patients with HCC: A systematic review. Expert Rev Gastroenterol Hepatol. 2020;14:383–400. doi: 10.1080/17474124.2020.1748010.
6. Han S, Wang C, Tong F, Li Y, Li Z, Sun Z, Sun Z. Prognostic impact of albumin-bilirubin score on the prediction of in-hospital mortality in patients with heart failure: a retrospective cohort study. BMJ Open. 2022;12:e049325. doi: 10.1136/bmjopen-2021-049325.