What Is The Impact Of Liver Function To Predict Mortality In Patients With Severe Aortic Stenosis And Reduced Ejection Fraction?

BACKGROUND
Liver is one of the target organs in patients with symptomatic severe aortic stenosis (AS) and reduced ejection fraction (EF). We aimed to evaluate the prognostic impact of liver function reserve as assessed by albumin-bilirubin score (ALBI) on 30-day and 1-year mortality and rehospitalization at 1 year in patients with severe symptomatic AS and reduced EF undergoing transcatheter aortic valve implantation (TAVI).

METHODS
The patients with severe symptomatic AS and reduced EF who were hospitalized between 2013- 2021 were included in this single center retrospective study. Preoperative bilirubin and albumin levels were used for ALBI calculation as in the original report. The total primary outcomes were defined as 30-day and 1-year all-cause mortality and hospitalization for decompensated heart failure within 1-year. Two groups generated based on ALBI scores; high(>-2.25) and low(≤-2.25) ALBI groups.

RESULTS
A total of 77 patients (49 male) were included and 29(37.7%) patients died within 1-year of follow-up with 17 corresponding to 30-day mortality. There was no difference between high and low ALBI groups in terms of length of hospital stay,postprocedural complications and re-hospitalization within 1-year while 30-day mortality (50.0% vs. %4.3, p<0.0001) and 1-year mortality (80.0 % vs.10.6%, p<0.0001) were significantly higher in the high ALBI group. Hence, total primary outcomes (86.7% vs. 44.7%, p<0.0001) were significantly higher in high ALBI group.

CONCLUSION
High ALBI score (≥- 2.25) was found as an independent risk factor associated with 30-day and 1-year mortality and total primary outcomes. The results of this study suggest that preprocedural assessment of the ALBI score gives additional information to stratify of patients with severe symptomatic AS with reduced EF.