Hypoalbuminemia as a Prognostic Marker in Alcoholic Cardiomyopathy: A TriNetX-Based Retrospective Analysis

Background Alcoholic cardiomyopathy (ACM) is a significant cause of heart failure with substantial morbidity and mortality. Hypoalbuminemia, a marker of malnutrition and systemic inflammation, may serve as a prognostic indicator in ACM patients. This study aimed to evaluate the prognostic significance of hypoalbuminemia in patients with alcoholic cardiomyopathy. Methods We conducted a retrospective cohort study using the TriNetX Research Network, analyzing data from 129 healthcare organizations. Adult patients (18–90 years) with alcoholic cardiomyopathy were stratified into two cohorts: hypoalbuminemia (albumin ≤ 3.40 g/dL; n = 5,754) and normal albumin (albumin ≥ 3.50 g/dL; n = 9,620). After propensity score matching, 5,241 patients remained in each cohort. Primary outcome was all-cause mortality. Secondary outcomes included cardiovascular complications, acute kidney injury, and hospital utilization over a 5-year follow-up period. Results Patients with hypoalbuminemia demonstrated significantly higher all-cause mortality compared to those with normal albumin levels (36.2% vs 15.1%; HR 3.341, 95% CI 3.072–3.633; p < 0.001). Hypoalbuminemia was associated with increased risks of cardiogenic shock (7.3% vs 4.3%; HR 2.241, 95% CI 1.883–2.667; p < 0.001), acute kidney injury (29.0% vs 18.8%; HR 2.157, 95% CI 1.943–2.395; p < 0.001), ventricular tachycardia (9.6% vs 8.7%; HR 1.510, 95% CI 1.313–1.738; p < 0.001), and pulmonary embolism (3.7% vs 3.0%; HR 1.692, 95% CI 1.362–2.103; p < 0.001). Paradoxically, patients with hypoalbuminemia had lower rates of pacemaker implantation (5.5% vs 8.3%; HR 0.847, 95% CI 0.726–0.988; p = 0.035). Conclusion Hypoalbuminemia serves as a powerful prognostic marker in alcoholic cardiomyopathy, associated with significantly increased mortality and cardiovascular complications. These findings suggest that albumin levels should be routinely monitored and nutritional interventions considered in ACM management to potentially improve outcomes.