The Authors Reply We appreciate the interest of Dr. Imamura in our recent paper, as well as his valuable comments (1). In our study, hypoalbuminemia was defined as a serum albumin level of 3.4 g/dL because the median serum albumin level was 3.4 g/dL, which is generally accepted as the cutoff value (2-4). In response to Dr. Imamura’s initial comment, we performed a receiver-operating characteristic (ROC) curve analysis, and 3.8 g/dL was found to be the ideal cutoff value for predicting the outcome in our dataset. However, hypoalbuminemia at admission, defined as a serum albumin level of 3.8 g/dL, was not associated with the long-term outcomes [hazard ratio (HR), 1.21; 95% confidence interval (CI), 0.70-2.22; p=0.511 in the pre-match model, and HR, 0.97; 95% CI, 0.45-2.07; p=0.934 in the post-match model]. The duration of follow-up varied across individual cases on the basis of the relatively long enrollment period (i.e., 5 years) and thus the numbers at risk decreased with the passage of time. In the Kaplan-Meier survival analyses, the two curves crossed after several years, as Dr. Imamura pointed out. However, the proportional hazards assumption was confirmed in both the pre-match and post-match models using log-minus-log survival graphs. It is often difficult to show the relationship between parameters/conditions in the acute phase and the long-term outcomes. However, many reports have investigated the relationships between parameters/conditions in the acute phase and long-term outcomes (5, 6). Again, we thank Dr. Imamura for his interest and comments on our paper.
[1]
H. Daida,et al.
Relationship between Hypoalbuminemia on Admission and Long-term Mortality in Patients with Acute Decompensated Heart Failure
,
2019,
Internal medicine.
[2]
Ann-Stephan Gori,et al.
Serum albumin level and hospital mortality in acute non‐ischemic heart failure
,
2017,
ESC heart failure.
[3]
Wen-Chung Yu,et al.
Hyponatremia and Worsening Sodium Levels Are Associated With Long‐Term Outcome in Patients Hospitalized for Acute Heart Failure
,
2016,
Journal of the American Heart Association.
[4]
M. López-Ibáñez,et al.
Hypoalbuminemia in acute heart failure patients: causes and its impact on hospital and long-term mortality.
,
2014,
Journal of cardiac failure.
[5]
S. Moore,et al.
Serum albumin and mortality in acutely decompensated heart failure.
,
2010,
American heart journal.
[6]
B. Lewis,et al.
Predictors of long‐term (4‐year) mortality in elderly and young patients with acute heart failure
,
2010,
European journal of heart failure.