Relationship between the Ratio of Red Cell Distribution Width to Albumin and 28-Day Mortality among Chinese Patients over 80 Years with Atrial Fibrillation.

INTRODUCTION: Atrial fibrillation (AF) is a prevalent heart arrhythmia in elderly adults aged 80 years or older. The red cell distribution width (RDW) to albumin ratio has been acknowledged as a reliable prognostic marker for poor outcomes in a variety of disorders. However, there exists limited scientific evidence on the association of RDW to albumin (RAR) with mortality in geriatric individuals with AF. METHODS: From January 2015 to June 2020, a retrospective study was conducted in a tertiary academic institution that diagnosed 1,141 elderly adults with AF. The RAR value was calculated as the ratio of RDW (%) to albumin (g/dL). The potential association between RAR and cardiovascular mortality and the risk of all-cause mortality within 28 days was evaluated by means of multivariable Cox regression analysis. RESULTS: The 28-day all-cause and cardiovascular mortality rates were 8.7% and 3.3%, respectively. Increased RAR tertiles were found to be significantly associated with greater all-cause mortality (T1: 1.6%; T2: 6.2%; T3: 18.1%, p < 0.001) and cardiovascular mortality (T1: 0.8%; T2: 2.9%; T3: 6.3%, p < 0.001) using Kaplan-Meier analysis. Continuous RAR had a positive association with all-cause mortality (hazard ratios [HR] = 1.42, 95% confidence interval [CI] 1.23-1.65) and cardiovascular mortality (HR = 1.31, 95% CI: 1.05-1.64), even after accounting for numerous confounding variables. In comparison to the T1 group, individuals with the highest RAR levels displayed a greater risk of all-cause mortality (HR = 2.73, 95% CI: 1.11-6.74) and cardiovascular mortality (HR = 2.59, 95% CI: 0.69-9.78). Increased RAR levels were related to higher rates of cardiovascular and all-cause mortality across almost all subgroups. CONCLUSION: RAR is independently correlated with 28-day all-cause mortality and cardiovascular mortality in AF-affected individuals aged ≥80.

Association between serum Klotho concentration and heart failure in adults, a cross-sectional study from NHANES 2007-2016.

BACKGROUND: Limited data exist on the association between serum Klotho concentration and heart failure (HF). METHODS AND RESULTS: We conducted a cross-sectional study of 13,625 participants aged 40-79 years in the National Health and Nutrition Examination Survey (NHANES) 2007-2016. Multivariable logistic regression models were used to examine the association between serum Klotho concentration (ln transformation) and HF. A total of 533 (2.9%) participants were identified to have HF, and participants with the lowest tertiles of serum Klotho concentration had the highest percentage of HF (T1: 3.8% vs. T2: 2.8% and T3: 2.1%, P < 0.001). After adjusting for potential confounders, ln (Klotho) was negatively and independently associated with the risk of HF (OR= 0.55, 95% CI 0.36-0.84). Meanwhile, compared with the T1 group, a higher serum Klotho concentration was associated with a lower risk of HF (tertile 2: OR = 0.93, 95% CI: 0.69-1.29, tertile 3: OR = 0.75, 95% CI: 0.52-1.09, P for trend 0.022). Finally, subgroup analyses indicated that lower Klotho concentrations significantly correlated with an increased risk of HF in half of the subgroups. CONCLUSION: Serum Klotho concentration was consistently and negatively associated with the presence of HF among US middle-aged and older adults.

The association between the prognostic nutritional index and 28-day mortality among atrial fibrillation patients in China over 80 years of age.

BACKGROUNDS AND AIMS: The most prevalent form of cardiac rhythm abnormality among older populations is atrial fibrillation (AF). The prognostic nutritional index (PNI) is a reliable predictor of mortality in various diseases. The association between the PNI and mortality among AF patients over 80 years remains uncleared. METHODS AND RESULTS: A retrospective assessment of AF cases admitted to a single cardiovascular disease unit in China between January 2015 and June 2020 was performed. The PNI at admission was defined as 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (per mm3). The association between PNI and cardiovascular disease (CVD)-related or all-cause mortality within 28 days was assessed via multivariable Cox regression. The analysis included 1141 patients. The CVD-related and all-cause mortality rates were 3.3% and 8.7%. Kaplan-Meier analyses revealed that cases with lower PNI tertiles exhibited higher all-cause mortality (T1: 7.6%; T2: 6.1%; T3: 2.4%, P < 0.001) or CVD mortality (T1: 6.3%; T2: 2.9%; T3: 0.8%, P < 0.001). After adjusting for potential confounders, continuous PNI was negatively related to the hazard of all-cause mortality (HR 0.92, 95% CI 0.89, 0.96) and CVD-related mortality (HR 0.90, 95% CI 0.84, 0.95). Compared to the T1 group, patients with a higher PNI exhibited a lower risk of all-cause mortality (P for trend 0.003) and CVD-related mortality (P for trend 0.005). Among most subgroups, CVD-related and all-cause mortality decreased with elevating PNI values. CONCLUSIONS: PNI is significantly negatively correlated with CVD-related and all-cause mortality among AF cases over 80 years.