Table 1
Population characteristics by tertiles of baseline ALBI score.
| VARIABLE | ALL | ALBI SCORE | p VALUE FOR TREND | ||
|---|---|---|---|---|---|
| TERTILE 1 (< –3.01) | TERTILE 2 (–3.01 to < 2.71) | TERTILE 3 (>= –2.71) | |||
| No. of patients (n) | 462 | 151 | 152 | 159 | |
| Gender, male | 253 (54.76%) | 89 (58.94%) | 76 (50.00%) | 88 (55.35%) | 0.540 |
| Age (years) | 58.00 (46.00, 67.00) | 53.00 (42.00, 66.00) | 56.00 (46.75, 66.00) | 62.00 (49.00, 70.50) | <0.001 |
| Family history of HCM | 40 (8.66%) | 16 (10.60%) | 12 (7.89%) | 12 (7.55%) | 0.344 |
| Family history of SCD | 15 (3.25%) | 6 (3.97%) | 6 (3.95%) | 3 (1.89%) | 0.297 |
| NYHA III-IV | 161 (34.85%) | 47 (31.13%) | 40 (26.32%) | 74 (46.54%) | 0.004 |
| Symptom | |||||
| Dyspnea | 257 (55.63%) | 72 (47.68%) | 92 (60.53%) | 93 (58.49%) | 0.059 |
| Chest pain | 248 (53.68%) | 84 (55.63%) | 87 (57.24%) | 77 (48.43%) | 0.199 |
| Syncope/pre-syncope | 144 (31.17%) | 44 (29.14%) | 56 (36.84%) | 44 (27.67%) | 0.760 |
| Palpitation | 174 (37.66%) | 55 (36.42%) | 61 (40.13%) | 58 (36.48%) | 0.999 |
| Medical history | |||||
| Prior thrombo-embolic event | 22 (4.76%) | 4 (2.65%) | 3 (1.97%) | 15 (9.43%) | 0.005 |
| Vascular diseases | 37 (8.01%) | 9 (5.96%) | 13 (8.55%) | 15 (9.43%) | 0.263 |
| Hypertension | 147 (31.82%) | 54 (35.76%) | 52 (34.21%) | 41 (25.79%) | 0.058 |
| diabetes | 39 (8.44%) | 10 (6.62%) | 12 (7.89%) | 17 (10.69%) | 0.197 |
| Atrial fibrillation | 82 (17.75%) | 16 (10.60%) | 25 (16.45%) | 41 (25.79%) | <0.001 |
| Hepatic disease | 41 (8.87%) | 10 (6.62%) | 14 (9.21%) | 17 (10.69%) | 0.209 |
| Therapy | |||||
| Aspirin | 85 (18.40%) | 34 (22.52%) | 24 (15.79%) | 27 (16.98%) | 0.215 |
| Clopidogrel | 28 (6.06%) | 9 (5.96%) | 10 (6.58%) | 9 (5.66%) | 0.908 |
| Beta blockers | 334 (72.29%) | 119 (78.81%) | 113 (74.34%) | 102 (64.15%) | 0.004 |
| ACEI or ARB | 92 (19.91%) | 30 (19.87%) | 32 (21.05%) | 30 (18.87%) | 0.821 |
| Intervention of obstruction | |||||
| none | 410 (88.74%) | 132 (87.42%) | 133 (87.50%) | 145 (91.19%) | 0.649 |
| alcohol septal ablation | 45 (9.74%) | 18 (11.92%) | 17 (11.18%) | 10 (6.29%) | |
| septal myectomy | 7 (1.52%) | 1 (0.66%) | 2 (1.32%) | 4 (2.52%) | |
| Device | |||||
| none | 406 (87.88%) | 135 (89.40%) | 134 (88.16%) | 137 (86.16%) | 0.390 |
| pacemaker | 21 (4.55%) | 7 (4.64%) | 5 (3.29%) | 9 (5.66%) | |
| ICD | 35 (7.58%) | 9 (5.96%) | 13 (8.55%) | 13 (8.18%) | |
| Hematological result | |||||
| ALT (IU/L) | 22.00 (16.00, 34.00) | 23.00 (17.00, 37.50) | 21.00 (14.00, 29.25) | 23.00 (16.00, 36.50) | 0.482 |
| AST (IU/L) | 26.00 (21.00, 33.00) | 26.00 (22.00, 32.00) | 24.00 (19.00, 29.25) | 27.00 (21.50, 38.00) | 0.135 |
| TBil (μmol/L) | 12.35 (9.03, 17.70) | 10.90 (8.50, 13.35) | 12.15 (9.07, 16.92) | 15.00 (10.40, 21.10) | <0.001 |
| Albumin (g/L) | 42.30 (39.50, 45.00) | 46.10 (44.60, 47.70) | 42.40 (41.60, 43.50) | 38.40 (35.50, 40.00) | <0.001 |
| Creatinine (μmol/L) | 80.10 (67.00, 94.55) | 81.00 (68.50, 92.50) | 76.00 (65.00, 92.00) | 81.50 (68.10, 100.75) | 0.314 |
| Urea nitrogen (mmol/L) | 6.04 (5.02, 7.78) | 6.01 (5.18, 7.13) | 5.80 (4.82, 7.38) | 6.41 (5.10, 8.72) | 0.072 |
| TG (mmol/L) | 1.25 (0.94, 1.87) | 1.57 (1.08, 2.28) | 1.29 (0.99, 1.79) | 1.04 (0.80, 1.40) | <0.001 |
| HDL-C (mmol/L) | 1.27 (1.03, 1.55) | 1.26 (1.02, 1.58) | 1.30 (1.08, 1.54) | 1.24 (0.96, 1.54) | 0.474 |
| LDL-C (mmol/L) | 2.41 (1.83, 2.90) | 2.51 (1.91, 2.99) | 2.54 (1.92, 2.95) | 2.23 (1.77, 2.83) | 0.026 |
| Hgb (g/L) | 136.04 (21.39) | 141.14 (19.70) | 134.88 (19.39) | 132.31 (23.81) | <0.001 |
| WBCC (109/L) | 6.32 (5.20, 7.78) | 6.60 (5.36, 7.69) | 6.19 (5.28, 7.56) | 6.12 (4.99, 8.21) | 0.152 |
| Neutrophils count (109/L) | 3.91 (3.04, 5.23) | 4.09 (3.21, 5.19) | 3.77 (3.04, 5.03) | 3.90 (2.95, 6.01) | 0.786 |
| Lymphocyte count (109/L) | 1.61 (1.26, 1.98) | 1.80 (1.44, 2.27) | 1.61 (1.31, 1.95) | 1.42 (1.04, 1.84) | <0.001 |
| NLR | 2.30 (1.70, 3.60) | 2.20 (1.60, 3.25) | 2.30 (1.70, 3.42) | 2.80 (1.90, 4.15) | <0.001 |
| Echocardiographic | |||||
| LVEDD (mm) | 43.00 (40.00, 46.75) | 44.00 (40.00, 47.00) | 42.50 (40.00, 46.00) | 42.00 (38.50, 47.00) | 0.054 |
| LA diameter (mm) | 40.00 (35.00, 45.00) | 40.00 (35.00, 44.00) | 39.00 (35.00, 45.00) | 40.00 (36.00, 45.50) | 0.345 |
| MWT (mm) | 19.00 (17.00, 22.00) | 19.00 (17.00, 22.00) | 19.00 (16.00, 22.00) | 19.00 (17.00, 21.00) | 0.501 |
| LVEF (%) | 68.00 (63.00, 72.00) | 69.00 (64.00, 73.00) | 68.50 (64.75, 72.00) | 68.00 (62.00, 71.00) | 0.003 |
| Resting LVOTG >= 30 mm Hg | 198 (42.86%) | 62 (41.06%) | 74 (48.68%) | 62 (38.99%) | 0.694 |
[i] Note: Values are mean ± SD, median (IQR) or n (%).
Abbreviations: ACEI = angiotensin-converting enzyme inhibitor, ALBI = albumin-bilirubin, ALT = alanine aminotransferase, ARB = angiotensin receptor blocker, AST = aspartate aminotransferase, HCM = hypertrophic cardiomyopathy, HDL-C = high density lipoprotein cholesterin, Hgb = hemoglobin, ICD = implantable cardioverter defibrillator, LA = left atrial, LDL-C = low density lipoprotein cholesterin, LVEDD = left ventricular end-diastolic dimension, LVEF = left ventricular ejection fraction, LVOTG = left ventricular outflow tract gradient, MWT = maximal left ventricular wall thickness, NLR = neutrophil to lymphocyte ratio, NYHA = New York Heart Association, SCD = sudden cardiac death, SD = standard deviation, TBil = total bilirubin, TG = triglyceride, WBCC = white blood cell count.
Figure 1
Association between ALBI score and HCM-related death.
Note: (A) smooth curve fitting. HR was adjusted for age, gender, family history of SCD, NYHA III-IV, dyspnea, syncope/pre-syncope, atrial fibrillation, AST, urea nitrogen, TG, NLR, LA diameter, MWT and Resting LVOTG >= 30 mm Hg. The solid line and ribbon depict the HR and 95% CI, respectively. (B) Kaplan-Meier curves.
Table 2
Associations of ALBI score with HCM-related death.
| ALBI SCORE | |||
|---|---|---|---|
| TERTILE 1 (< –3.01) | TERTILE 2 (–3.01 to < 2.71) | TERTILE 3 (>= –2.71) | |
| No. of patients (n) | 151 | 152 | 159 |
| HCM-related death (n) | 5 | 9 | 38 |
| HF-related death | 2 | 2 | 22 |
| Stroke-related death | 1 | 2 | 7 |
| SCD | 1 | 5 | 8 |
| HCM-related postoperative death | 1 | 0 | 1 |
| Follow-up time (PYs) | 745 | 763.0 | 649.9 |
| Mortality rate for HCM-related death (95% CI)⁎ | 0.7 (0.1–1.3) | 1.2 (0.4–1.9) | 5.8 (4–7.7) |
| Unadjusted HR for HCM-related death (95% CI), p | 1 | 1.78 (0.60–5.32), 0.300 | 8.35 (3.28–21.22), <0.001 |
| Adjusted HR for HCM-related death (95% CI), p | |||
| Model 1 | 1 | 1.73 (0.58–5.17), 0.329 | 8.14 (3.16–20.94), <0.001 |
| Model 2 | 1 | 1.66 (0.55–5.01), 0.368 | 5.96 (2.28–15.55), <0.001 |
| Model 3 | 1 | 1.27 (0.41–3.90), 0.674 | 4.45 (1.66–11.99), 0.003 |
| Model 4 | 1 | 1.27 (0.42–3.89), 0.673 | 4.28 (1.59–11.50), 0.004 |
| Model 5 | 1 | 1.30 (0.42–3.99), 0.648 | 4.43 (1.65–11.89), 0.003 |
[i] Note: Model 1 with adjustment for age and gender.
Model 2 with adjustment for model 1 plus clinical parameters, including NYHA III-IV, dyspnea, prior TE and atrial fibrillation.
Model 3 with adjustment for model 3 plus laboratory results, including AST, urea nitrogen, TG and NLR.
Model 4 with adjustment for model 4 plus echocardiographic parameters, including LA diameter and LVEF.
Model 5 with adjustment for age, gender, family history of SCD, NYHA III-IV, dyspnea, syncope/pre-syncope, atrial fibrillation, AST, urea nitrogen, TG, NLR, LA diameter, MWT and Resting LVOTG >= 30 mm Hg.
⁎Per 100 PYs.
Abbreviations: CI = confidence interval, HRs = hazard ratios, PYs = person-years, other abbreviations as in Table 1.
Figure 2
Stratified analyses of HCM-related death.
Note: each stratification was adjusted for age, gender, family history of SCD, NYHA III-IV, dyspnea, syncope/pre-syncope, atrial fibrillation, AST, urea nitrogen, TG, NLR, LA diameter, MWT and Resting LVOTG >= 30 mm Hg, except the stratification factor itself. Grouping criteria of continuous variables were based on the median values. The p value for interaction represents the likelihood of interaction between variable and ALBI score.
† The analyses failed because of no death in the tertiles 1–2.
In addition, hepatic diseases included viral hepatitis (n = 10), alcoholic hepatitis (1), fatty liver (n = 8), diseases of the biliary system (n = 16), liver cirrhosis (n = 2) and unknown reasons (n = 4).
Figure 3
Time-dependent AUCs for ALBI score prdicting HCM-related death.
Note: the curve was calculated every 0.2 years (from 1 to 10 years). In the figure, the solid line depicts the AUCs, and the ribbon represents 95% CI.
Figure 4
Kaplan-Meier analysis showing cumulative HCM-related death by categorical changes of ALBI score.
Table 3
Factors associated with ALBI score in multivariable linear models.
| β | SE OF β | p VALUE | |
|---|---|---|---|
| (Intercept) | –3.074 | 0.170 | <0.001 |
| NLR | 0.015 | 0.003 | <0.001 |
| TG | –0.069 | 0.018 | <0.001 |
| Age | 0.005 | 0.001 | <0.001 |
| AST | 0.001 | 0.000 | 0.001 |
| NYHA III-IV | 0.098 | 0.042 | 0.021 |
| Gender | 0.011 | 0.038 | 0.779 |
| Family history of SCD | –0.161 | 0.103 | 0.118 |
| Dyspnea | 0.039 | 0.040 | 0.327 |
| Syncope/pre-syncope | 0.031 | 0.040 | 0.441 |
| Atrial fibrillation | 0.078 | 0.051 | 0.129 |
| Urea nitrogen | 0.004 | 0.005 | 0.370 |
| LA diameter | –0.002 | 0.003 | 0.568 |
| MWT | –0.004 | 0.004 | 0.354 |
| Resting LVOTG >= 30 mm Hg | –0.002 | 0.039 | 0.951 |
[i] Abbreviations: SE= standard error, other abbreviations as in Tables 1 and S1.