Association between the albumin-hemoglobin index and mortality in older adults with dysphagia.

OBJECTIVES

Dysphagia is common in older adults and is associated with malnutrition, inflammation, and increased mortality. The albumin-hemoglobin index (AHI), calculated as serum albumin (g/dL) plus hemoglobin (g/dL), may reflect both nutritional and oxygen-carrying reserves. The aim of this study was to investigate whether AHI is independently associated with all-cause mortality in older adults with dysphagia requiring nutritional support.

METHODS

This was a single-center retrospective cohort study of 253 older adults (aged ≥50 years; mean 83.1 ± 9.3) with clinically diagnosed dysphagia who initiated percutaneous endoscopic gastrostomy (PEG) or total parenteral nutrition (TPN) between January 2014 and January 2017 in Japan. AHI was calculated at baseline and categorized into tertiles (T1: <13.1, T2: 13.1-15.3, T3: ≥15.3). Associations between AHI and all-cause mortality were assessed using Kaplan-Meier curves and multivariable Cox proportional hazards models. Prognostic accuracy was compared with the CONUT score and Prognostic Nutritional Index (PNI) using ROC analysis.

RESULTS

Over a median follow-up of 601 days, 138 deaths (54.5%) occurred. Median survival times were 125, 741, and 935 days for T1, T2, and T3, respectively (P < 0.0001). In the fully adjusted model, each 1-unit increase in baseline AHI was independently associated with a 16% reduction in all-cause mortality (adjusted HR = 0.84; 95% CI: 0.77-0.92). AHI demonstrated superior prognostic accuracy compared to the CONUT score (AUC: 0.742 versus 0.681, P = 0.04) and comparable accuracy to PNI (AUC: 0.742 versus 0.721, P = 0.48).

CONCLUSIONS

Higher baseline AHI is independently associated with improved survival in older adults with dysphagia. AHI is a pragmatic, cost-effective, and readily implementable prognostic tool for clinical practice.