Liver dysfunction has emerged as a clinically relevant prognostic marker in heart failure (HF). A retrospective analysis presented at the Heart Failure 2026 evaluated whether changes in albumin-bilirubin (ALBI) score during hospitalization were associated with post-discharge outcomes in patients admitted with acute HF.
The study included 226 patients hospitalized for acute HF who remained admitted for at least 7 days. ALBI scores were calculated at admission and at discharge, and patients were categorized into ALBI-improved and ALBI-deteriorated groups based on changes during hospitalization. The primary outcome was a composite of all-cause death or unplanned nonfatal HF hospitalization after discharge.

Findings

• During a median follow-up of 599 days, 34 all-cause deaths and 66 nonfatal HF hospitalizations occurred.
• Kaplan–Meier analysis showed significantly higher event-free rates in the ALBI-improved group compared with the ALBI-deteriorated group (log-rank p < 0.0001).
• In univariate analysis, age, body mass index, systolic blood pressure, left ventricular ejection fraction, tricuspid regurgitation velocity, hemoglobin, estimated glomerular filtration rate, BNP concentration, ALBI score at discharge, and ALBI improvement status were associated with outcomes.
• Higher hemoglobin levels were independently associated with favorable outcomes (HR: 0.83; 95% CI: 0.72–0.96; p = 0.015).
• Lower BNP concentrations were also independently associated with favorable outcomes (HR: 1.001; 95% CI: 1.0003–1.002; p = 0.0065).
• Patients in the ALBI-improved group had significantly lower risk of adverse outcomes after discharge (HR: 0.32; 95% CI: 0.18–0.54; p < 0.0001).

The findings suggest that changes in ALBI score during hospitalization may provide additional prognostic information beyond single-time-point assessment in patients with acute HF.