Evidence map›Paper›PMID 41452958›Full record

Observational studyEuropean journal of clinical investigation2026

Albumin, urea-to-albumin ratio, or the albumin-to-creatinine ratio to predict outcomes in heart failure with mildly reduced ejection fraction.

Alexander Schmitt, Ibrahim Akin, Marielen Reinhardt, Noah Abel, Felix Lau, Jonas Dudda, Mohammad Abumayyaleh, Kathrin Weidner, Thomas Bertsch, Daniel Duerschmied and 2 more

Registry-linked trialAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in European journal of clinical investigation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05603390 (Heart Failure With Mildly Reduced Ejection Fraction Registry), which is not on this map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05603390 unknown statusnot on this map

Heart Failure With Mildly Reduced Ejection Fraction Registry (HARMER)

TypeobservationalSponsorUniversitätsmedizin MannheimRan2015 to 2023Enrolled2,200ConditionsHeart Failure
3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Alexander SchmittDepartment of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany.
Ibrahim AkinDepartment of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany.
Marielen ReinhardtDepartment of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany.
Noah AbelDepartment of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany.
Felix LauDepartment of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany.
Jonas DuddaDepartment of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany.
Mohammad AbumayyalehDepartment of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany.
Kathrin WeidnerDepartment of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany.
Thomas BertschInstitute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany.
Daniel DuerschmiedDepartment of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany.
Michael BehnesDepartment of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany.
Tobias SchuppDepartment of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, Medical Faculty Mannheim, University Medical Centre Mannheim, Heidelberg University, Heidelberg, Germany.ORCID https://orcid.org/0000-0001-8171-7617

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThis study investigates the prognostic impact of albumin, the urea-to-albumin ratio (UAR), and albumin-to-creatinine ratio (ACR) in patients with heart failure with mildly reduced ejection fraction (HFmrEF), since hypoalbuminemia, renal disease and malnutrition often coincide with heart failure (HF).

methodsConsecutive patients hospitalized with HFmrEF at one university medical centre were retrospectively included from 2016 to 2022. Patients were stratified into quartiles based on albumin, the UAR, and ACR. The primary endpoint was all-cause mortality at 30 months (median follow-up), key secondary endpoint was long-term HF-related rehospitalization.

resultsThe study cohort comprised 2,061 patients with HFmrEF with a median albumin level of 32.4 g/L. Albumin levels, the UAR and ACR were predictive for the risk of long-term all-cause mortality, which was still observed after multivariable adjustment (albumin Q1 vs. Q4: HR = 2.260; 95% CI 1.623-3.148; p = .001 / UAR Q4 vs. Q1: HR = 1.507; 95% CI 1.071-2.119; p = .019/ACR Q1 vs. Q4: HR = 2.208; 95% CI 1.528-3.190; p = .001). However, neither albumin nor the UAR or ACR predicted the risk of HF-related rehospitalization (albumin Q1 vs. Q4: HR = 1.117; 95% CI .678-1.842; p = .664 / UAR Q4 vs. Q1: HR = 1.589; 95% CI .922-2.738; p = .095 / ACR Q1 vs. Q4: HR = 1.112; 95% CI .624-1.981; p = .720).

conclusionsHypoalbuminemia is common in hospitalized HFmrEF patients. Low albumin levels, ACRs, and elevated UARs independently predicted long-term all-cause mortality, but not HF-related rehospitalization. The UAR and ACR did not provide a clinically significant predictive advantage over albumin levels alone.

trial registrationClinicalTrials.gov Identifier: NCT05603390 (date of registration: 10.10.2020).

Indexed as

CreatinineHeart FailureSerum AlbuminUreaAgedAged, 80 and overCause of DeathFemaleHumansHypoalbuminemiaMaleMiddle AgedPatient ReadmissionPrognosisRetrospective StudiesStroke VolumeCreatinineSerum AlbuminUreaalbuminalbumin‐derived ratiosheart failure with mildly reduced ejection fractionHFmrEFprognosis

Identifiers

PMID41452958
PMCPMC12827846

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.