ArticleVascular health and risk management2026
Association and Discriminative Performance of a Bilirubin-D-Dimer-Albumin Index for LVEF <45% in Patients with Heart Failure: A Single-Centre Retrospective Study.
Article in Vascular health and risk management, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Accurate identification of reduced left ventricular ejection fraction (LVEF) is important for risk stratification and management of patients with heart failure (HF). Because HF involves multiple interrelated pathophysiological processes, a combination of biomarkers may provide information beyond that offered by individual markers. This study evaluated the association and discriminatory performance of the bilirubin-D-dimer-albumin (BDA) Index for identifying LVEF <45% and compared its performance with that of NT-proBNP. Methods: In this single-centre retrospective study, 338 patients with HF were categorized according to echocardiographic LVEF as <45% (n=149) or ≥45% (n=189). The BDA Index was calculated as ln(total bilirubin [µmol/L]) × ln(D-dimer [ng/mL]) / albumin [g/L]. Discrimination was assessed using receiver operating characteristic (ROC) analysis and DeLong's test. Multivariable logistic regression was used to evaluate the association between the BDA Index and LVEF <45%, with internal validation performed using 1000 bootstrap samples and 10-fold cross-validation. Decision curve analysis (DCA) was used to assess the potential clinical utility of the model. Results: The BDA Index was significantly higher in patients with LVEF <45% (P<0.001). Its AUC was 0.902 (95% CI, 0.870-0.934), compared with 0.773 (95% CI, 0.723-0.823) for NT-proBNP (DeLong's test, P<0.001). At the Youden-derived cutoff of 0.435, sensitivity and specificity were 87.9% and 78.3%, respectively. After multivariable adjustment, each 0.1-unit increase in the BDA Index was associated with LVEF <45% (OR, 4.65; 95% CI, 2.94-7.36; P<0.001). Adding the BDA Index significantly improved model fit (likelihood-ratio χ Conclusion: In this single-centre retrospective cohort, the BDA Index showed good discriminatory performance for identifying LVEF <45% and provided additional information beyond NT-proBNP and other clinical and laboratory variables. Prospective multicentre studies with independent external validation are needed to assess its reproducibility, calibration, and potential clinical utility.
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