A review of toxicity testing protocols and endpoints with Artemia spp.

Artemia spp. is an historically popular biological model still requiring an official internationally based standardization. Several endpoints are currently available. Short-term acute endpoints include biomarker (acetylcholinesterase; heat stress proteins; lipid peroxidation; thiobarbituric acid reactive substances; thioredoxin reductase; glutathione-peroxidase; glutathione S-transferase; glutathione reductase; aldehyde dehydrogenase; and adenylpyrophosphatase and Fluotox), hatching (dry biomass, morphological disorders and size), behavioral (swimming speed and path length), teratogenicity (growth), and immobilization (meaning mortality after 5–30 s observation). Long-term chronic tests focus on growth, reproduction and survival or mortality after 7–28 d exposure from larval to adulthood stage. We analyzed each test looking at its endpoint, toxicant and experimental design including replicates, exposure time, number of exposed cysts or organisms and their relative life stage, exposure conditions during hatching and testing (salinity, pH, light intensity, aeration dilution media, and food supply), type of testing chambers, and quality assurance and quality control criteria. Similarities and differences between the identified approaches were highlighted. Results evidenced that hatching 24 h short-term and 14 d long-term mortality are the most promising Artemia spp. protocols that should go forward with international standardization.     

The validation of common European class boundaries for river benthic macroinvertebrates to facilitate the intercalibration process of the Water Framework Directive

The Water Framework Directive (WFD) requires that all the water bodies in Europe be protected and enhanced to achieve Good Ecological Status by 2015. The intercalibration of the biological monitoring results of Member States has to be carried out in relation to classification tasks to guarantee a common understanding of ‘Good Ecological Status’ at a European level. An intercalibration exercise was carried out within the framework of different Geographical Intercalibration Groups (GIGs), each composed of a group of countries that share similar river types and have a discrete geographical range. By means of the intercalibration exercise, common European boundaries were proposed for river invertebrate assessment methods within each GIG. The purpose of this study was to validate the boundaries proposed for the formal intercalibration exercise. A benchmark data set was used, which comprised data, collected in different European countries that satisfied WFD requirements. The data set included a set of reference sites and provided evidence of a high degree of comparability among countries. The STAR Intercalibration Common Metric index (STAR_ICMi) was calculated for benchmark samples and was selected as the index in which national assessment boundaries were expressed. It was applied for the intercalibration exercise in two GIGs. For the STAR_ICMi, the coefficient of variation was also calculated, demonstrating a comparable variability with indices that are based on species level identification. A fixed percentile of reference samples STAR_ICMi values was selected as the boundary between High and Good status. The range from this fixed percentile to the lowest possible value was divided into four equal parts to obtain the remaining class boundaries. The resulting High/Good and Good/Moderate boundaries were compared to the boundaries proposed by GIGs and proved to be in line with those defined in the intercalibration exercise. Even if, for the intercalibration exercise, some procedures to check the Member States (MS) data sets where put into practice, it is the responsibility of each state to guarantee the WFD compliancy of their reference conditions and methods. Accordingly, the process of validation explained in this article, or similar ones, can be an important step forward and demonstrate the comparability of the actual boundaries.     

Effects of Acute Swimming Exercise on Some Elements in Rats

The objective of the present study is to explore the effects of acute swimming exercise on plasma levels of some elements in rats, immediately after the exercise, and 24 and 48 h later. The study included 40 adult male rats of Spraque Dawley species, which were equally allocated to four groups. Group 1: General Control Group; Group 2: Swimming Group, the group that was decapitated immediately after 30-min acute swimming exercise; Group 3: Swimming Group, the group that was decapitated 24 h after 30-min acute swimming exercise; Group 4: Swimming Group, the group that was decapitated 48 h after 30-min acute swimming exercise. Plasma copper (Cu), iron (Fe), magnesium (Mg), phosphorus (P), selenium (Se), zinc (Zn) levels were determined according to atomic emission method in the blood samples collected from the animals by decapitation method. Measurements conducted immediately after acute swimming exercise (group 2) showed a significant decrease in Se and Zn levels (p < 0,01) and a significant increase in P levels (p < 0,01), when compared to group 1. Measurements carried out 24 h after the exercise (group 3) demonstrated a significant increase in all parameters except for Mg, in comparison to groups 1 and 2 (p < 0,01). It was seen in the measurements made 48 h after the exercise (group 4) that all parameters were restored to control values. The results of our study show that acute swimming exercise significantly changes plasma Cu, Fe, P, Se, and Zn levels.     

Acute toxicity of a household bleach,sodium hypochlorite,to a whirligig beetle Orectogyrus alluaudi Régimbart, 1889 (Coleoptera: Gyrinidae)

Acute response of Orectogyrus alluaudi Régimbart, 1889 to sodium hypochlorite was reported after a 48-h acute toxicity test in an imitated field condition. O. alluaudi belongs to the water beetle family Gyrinidae (whirligig beetles) which includes more than 700 species. The test organisms were exposed to various concentrations of sodium hypochlorite ranging from 10 to 160 mg/l along with the control, and median lethal concentration (LC₅₀) values at 24 and 48 h of exposure were assessed. Mortality increased with the concentration of exposure. The 24 and 48 h LC₅₀ values estimated for sodium hypochlorite were 87.30 (73.21–107.06) and 72.32 (62.24–84.53) mg/l, respectively. A significant mortality (P < 0.001) was observed at 40, 80 and 160 mg/l of sodium hypochlorite when compared with the control. Addition of sodium hypochlorite altered the alkalinity and pH of the test water. Behavioural responses such as agitation and disorientation were also observed. The finding showed that indiscriminate use of the household bleach would have serious impact on the bionomics of this species.     

Protective effects of sulforaphane and aerobic exercise on acute alcoholic hepatic injury in mice

ObjectiveThe paper intends to study the protective effects of sulforaphane (SF) on acute alcoholic hepatic injury in mice by intragastric administration of SF, aerobic exercise and the approach of SF integrated with aerobic exercise.Methodology60 NIH mice were randomly divided into 6 groups of equal number according to their body weight and were intragastrically administrated with 50% ethanol. The serum and liver indexes of each group of mice were detected, and the liver was stained with oil red O for pathological examination.ResultsCompared with the model group, the serum TG and the ratio of liver to body weight of the model mice that suffered from acute alcoholic hepatic injury could be significantly decreased in the group that practiced aerobic exercise, the group administered with SF, and the group treated with the approach of SF integrated with aerobic exercise (P < 0.05). The contents of TG and MDA in liver could be significantly decreased (P < 0.05) and SOD activity could be significantly increased (P < 0.05) both in the group administered with SF and the group treated with the approach of SF integrated with aerobic exercise. Serum VLDL (P < 0.05) could also be significantly reduced in the group treated with the approach of SF integrated with aerobic exercise.ConclusionBoth SF and aerobic exercise could alleviate alcohol-induced acute alcoholic hepatic injury in mice possibly thanks to the working mechanism related to antioxidant stress that reduced the harm posed by alcohol on hepatic cells. In addition, the protective effect of SF on acute alcoholic hepatic injury in mice was stronger than that of aerobic exercise, while the approach of SF integrated with aerobic exercise had the strongest protective effect on acute alcoholic hepatic injury in mice.     

Plasma free and sulphated catecholamines after ultra-long exercise and recovery

We investigated the early and late effects of two types of ultra-long exercise on sympatho-adrenal and dopaminergic activity. With this aim both free and sulphoconjugated plasma catecholamines (CA), noradrenaline (NA), adrenaline (A), and dopamine (DA) were determined in two groups of athletes immediately after completion of 24-h running or a 10-h triathlon and on recovery during the next 1-3 days. Both races stimulated the sympathetic activity, but differences were observed in the CA pattern: the 24-h run induced a marked elevation of free and sulphoconjugated NA (+175% and +180%, respectively) but failed to alter significantly A and DA levels. The triathlon challenge increased the three conjugated CA (NA sulphate +350%; A sulphate +110%; DA sulphate +270%) and to a lesser extent free CA (NA +45%; A +30%). On the first post-exercise morning, a sustained intense noradrenergic activity was still present in the 24 h-runners, as evidenced by the large increase in free and sulphated NA levels (+140% and +100%, respectively). Such a prolonged activity was also indicated after completion of the triathlon, by the increase of NA sulphate (+140%) observed on the 1st recovery day. However, after the triathlon there was a decreased release of A from the adrenal medulla for several days. These data show that both types of ultralong exercise are able to induce for several hours a sustained sympathetic activation during the test and in the recovery period. Furthermore, the study shows that plasma conjugated CA may provide delayed and cumulative indexes of sympathetic activation, complementary to the instantaneous markers such as free CA.     

Synchrony in the hatching of eggs in the desert locust <Emphasis Type="Italic">Schistocerca gregaria</Emphasis> (Orthoptera: Acrididae): egg condition influences hatching time in the laboratory and under simulated field temperatures

This study examined the time of hatching of the desert locust Schistocerca gregaria Forskål (Orthoptera: Acrididae) in the laboratory to test the effect of eggs within a pod versus individualized eggs. The pod organization of eggs is thought to play a role in controlling hatching time and to facilitate synchronous hatching at constant temperatures. In the present study, we examined the hatching times of eggs in a pod and individualized eggs under 24-h thermocycles and simulated field temperatures. We tested two patterns of thermocycles consisting of a 12-h thermoperiod (35 or 30 °C) and 12-h cryoperiod (low temperature period; 30 or 25 °C), and two patterns of field temperatures observed in a natural habitat, Mauritania, in May and September. The majority of eggs hatched during low temperature periods in all patterns tested. In addition, the variances of hatching times for individualized eggs were significantly greater than for egg pods in which a clear peak of time of hatching was observed. We show that egg condition influences hatching time under thermocycles of constant and fluctuating temperatures in the laboratory, and may play a role in the adaptive time of hatching.     

Factors affecting piglet mortality during the first 24 h after the onset of parturition in large litters: effects of farrowing housing on behaviour of postpartum sows

The present study aimed to identify the factors that affect immediate (within 24 h after farrowing onset) postnatal piglet mortality in litters with hyperprolific sows, and investigate their associations with behaviour of postpartum sows in two different farrowing housing systems. A total of 30 sows were housed in: (1) CRATE (n=15): the farrowing crate closed (0.80×2.20 m) within a pen (2.50×1.70 m), and (2) OPEN (n=15): the farrowing crate open (0.80×2.20×1.80 m) within a pen (2.50×2.40 m) with a provision of 20 ls of hay in a rack. A total of 518 live born piglets, produced from the 30 sows, were used for data analyses during the first 24 h after the onset of parturition (T24). Behavioural observations of the sows were assessed via video analyses during T24. Total and crushed piglet mortality rates were higher in OPEN compared with CRATE (P<0.01, for both). During T24, the OPEN sows tended to show higher frequency of postural changes (P=0.07) and duration of standing (P=0.10), and showed higher frequencies of bar-biting (P<0.05) and piglet trapping (P<0.01), when compared with the CRATE sows. During T24, the mortality rates caused by crushing were correlated with the piglet trapping event (r=0.93, P<0.0001), postural changes (r=0.37, P<0.01), duration of standing (r=0.32, P<0.01) and frequency of bar-biting behaviour (r=0.51, P<0.01) of the sows (n=30). In conclusion, immediate postnatal piglet mortality, mainly due to crushing, may be associated with potential increases in frequency of postural changes, duration of standing and incidence of piglet trapping in postpartum sows in the open crate system with large litters.     

Endurance and strength training effects on physiological and muscular parameters during prolonged cycling

PurposeThis study investigated the effects of a combined endurance and strength training on the physiological and neuromuscular parameters during a 2-h cycling test.MethodsFourteen triathletes were assigned to an endurance-strength training group and an endurance-only training group. They performed three experimental trials before and after training: an incremental cycling test to exhaustion, a maximal concentric lower-limbs strength measurement and a 2-h cycling exercise. Physiological parameters, free cycling chosen cadence and the EMG of Vastus Lateralis (VL) and Rectus Femoris (RF) were analysed during the 2-h cycling task before and after a strength training programme of 5 weeks (three times per week).ResultsThe results showed that the maximum strength and the isometric maximal voluntary contraction (isoMVC) after training were significantly higher (P < 0.01) and lower (P < 0.01) than those before training, respectively, in endurance-strength training group and endurance-only group. The physiological variables measured during the cycling tests and the progressive increase (P < 0.01) in EMGi_(VL) and EMGi_(RF) throughout the 2-h cycling test did not differ between the two groups before and after training, except for the variation of EMGi_(VL) over the cycle time which was stabilized during the second hour of the 2-h cycling test due to training in endurance-strength training group. The decrease in free cycling chosen cadence observed in pre-training (P < 0.01) was also replaced by a steady free cycling chosen cadence for the endurance-strength training group during the second hour of exercise.ConclusionThis study confirmed the decrease in the free cycling chosen cadence with exercise duration and demonstrated that a specific combined endurance and strength training can prevent this decrease during a 2-h constant cycling exercise.     

Ingestion and Adsorption of Bacillus thuringiensis subsp. israelensis by Gammarus lacustris in the Laboratory

Several groups of Gammarus lacustris adults were exposed to solutions containing 0.5 and 5.0 mg of Bacillus thuringiensis subsp. israelensis per liter for 1- or 24-h periods by using traditional static bioassay exposure procedures. During a postexposure holding period, fecal pellets were removed and plated on tryptic soy agar to determine B. thuringiensis subsp. israelensis spore content. The experiments verified that traditional exposure procedures assure ingestion of B. thuringiensis subsp. israelensis spores and provided a mean dose estimate of 1,948 spores ingested per test animal with a 95% confidence interval ranging from 891 to 4,296 (1-h exposure, 5.0 mg/liter). It was also found that dose level is highly dependent upon both exposure duration and concentration and that relatively short exposures can result in a relatively long-term retention of spores postexposure (≥30 days). Body burden experiments established that large numbers of spores adsorb to the bodies of test animals during exposure and may in part explain the long-term retention of spores in the test system postexposure. These results imply that in field applications of microbial control agents, toxicologically unaffected but exposed organisms might transport the agent to untreated sites, expanding the effective treatment area and the number of organisms exposed.     

Direct comparison of assessment methods using benthic macroinvertebrates: a contribution to the EU Water Framework Directive intercalibration exercise

The aim of the intercalibration exercise presently performed by the EU is to identify and resolve significant inconsistencies between the ecological quality classifications of EU Member States and the normative definitions of the EU Water Framework Directive. Based on benthic macroinvertebrate data of two European stream types (small siliceous mountain streams and medium-sized lowland streams in Central and Western Europe) we correlated the indices of 10 river quality assessment methods (ASPT, BMWP, DSFI, German Multimetric Index, Saprobic Indices) applied in Austria, Czech Republic, Denmark, Germany, Poland, Slovak Republic, Sweden and United Kingdom. National class boundaries were compared via regression analysis. Assessment methods of the same type (Saprobic Indices, BMWP/ASPT scores) showed best correlation results (R²>0.7). The good quality status boundaries of the national methods deviated up to 25%; thus indicating the necessity to harmonize the national classification schemes. Prerequisites of the presented intercalibration approach are (1) a sufficiently large and consistent dataset representative of the respective common intercalibration types and (2) agreement on common type specific reference conditions.     

Comparative analysis of the larvicidal activity of temephos (EC50) and novaluaron (EC10) to control Anopheles stephensi in Sri Lanka

BackgroundAnopheles stephensi was first recorded in the coastal area of Mannar District, Sri Lanka, in December 2016. Since then, this vector has been isolated from other districts in the Northern and Eastern Provinces of Sri Lanka. Chemical control is the main arm of vector control that can be used to reduce the vector densities within a short period. Thus, the present study aimed at evaluating the efficacy of using selected insecticides for the control of An. stephensi larvae.MethodThe third and fourth instar larval stages of An. stephensi (F2 generation) of field mosquitoes that were caught using cattle baited net trap collections from Columbuthurai, Kurunagar, and Navanthurai areas in Jaffna District, Sri Lanka, were obtained from the laboratory colony established at Jaffna. Batches of 100 larvae were taken for experiments and introduced separately to a concentration series of temephos and novaluron (0.04–400 ppm). A control test was also performed at each setup without introducing insecticides. The mortality rates of An. stephensi larvae exposed to different concentrations of larvicides were recorded at 1, 24 and 48-h intervals. The experiment was replicated five times at individual concentrations for each selected chemical. Data were analyzed using the General Linear Model (GLM) and Probit analysis.ResultsThe highest mortality rate (100%) at a 1-h exposure period was observed from temephos at >100 ppm. The mortality rates varied significantly for different concentrations and larvicides (p < 0.05). At 24-h of the exposure period, the 100% mortality of An. stephensi larvae were observed from both temephos and novaluron even at 0.04 ppm.ConclusionBoth temephos and novaluron reported 100% mortality rates in An. stephensi larvae at 1-h and 24-h exposure periods. Based on the findings, temephos and novaluron can be recommended as effective larvicides for chemical-based control of An. stephensi in Jaffna, Sri Lanka. Further, it is recommended to conduct a field-based study, where habitat types and water quality are highly heterogeneous and may affect the residual activity.     

Comparing aspirations: intercalibration of ecological status concepts across European lakes for littoral diatoms

Eleven European countries participated in an exercise to harmonise diatom-based methods used for status assessment in lakes. Lakes were divided into low, medium and high alkalinity types for this exercise. However, it was not possible to perform a full intercalibration on low alkalinity lakes due to the short gradient and confounding factors. Values of the Trophie Index were computed for all samples in order that national datasets could all be expressed on a common scale. Not all participants had reference sites against which national methods could be standardised and, therefore, a Generalised Linear Modelling approach was used to control the effect of national differences in datasets. This enabled the high/good and good/moderate status boundaries to be expressed on a common scale and for deviations beyond ±0.25 class widths to be identified. Those countries which had relaxed boundaries were required to adjust these to within ±0.25 class widths whilst the intercalibration rules allowed those countries with more stringent boundaries to retain these. Despite biogeographical and typological differences between countries, there was broad agreement on the characteristics of high, good and moderate status diatom assemblages, and the exercise has ensured consistent application of Water Framework Directive assessments around Europe.     

A comparison of national approaches to setting ecological status boundaries in phytobenthos assessment for the European Water Framework Directive: results of an intercalibration exercise

The European Union (EU)’s Water Framework Directive (WFD) requires that all Member States participate in intercalibration exercises in order to ensure that ecological status concepts and assessment levels are consistent across the EU. This paper describes one such exercise, performed by the countries in the Central/Baltic Geographical Intercalibration Group stretching from Ireland in the west to Estonia in the east and from the southern parts of Scandinavia to the northern regions of Spain and Italy (but excluding alpine regions, which were intercalibrated separately). In this exercise, methods used to measure ecological status of rivers using benthic diatoms were compared. Ecological status is estimated as the ratio between the observed value of a biological element and the value expected in the absence of significant human impact. Approaches to defining the ‘reference sites’, from which these ‘expected’ values were derived, varied from country to country. Minimum criteria were established as part of the exercise but there was still considerable variation between national reference values, reflecting typological differences that could not be resolved during the exercise. A simple multimetric index was developed to compare boundary values using two widely used diatom metrics. Boundary values for high/good status and good/moderate status set by each participant were converted to their equivalent values of this intercalibration metric using linear regression. Variation of ±0.05 EQR units around the median value was considered to be acceptable and the exercise provided a means for those Member States who fell significantly above or below this line to review their approaches and, if necessary, adjust their boundaries. Handling editor: J. Padisak     

The acute toxicity of fenitrothion on narrow-clawed crayfish (Astacus leptodactylus Eschscholtz, 1823) in association with biomarkers of lipid peroxidation

The aim of this research was to evaluate the acute toxicity of fenitrothion to the crayfish (Astacus leptodactylus Eschscholtz, 1823), which is chosen as an alternative aquatic organism to fish by using the static test system and evaluate the basic lipid peroxidation parameters for the first 24 h. Crayfish of 27.3 ± 0.56 g mean weight and 10.0 ± 0.72 cm mean length were selected for the bioassay experiments. The experiments were repeated three times in 20 liters of tap water. The temperature of water was 21 ± 1°C. The data obtained were statistically evaluated by using a computer program developed by the United States Environmental Protection Agency, based on Finney's probit analysis method and the 96-h LC(50) value for crayfish was calculated to be 15.75 μg/L. The 95% lower and upper confidence limits for the LC(50) were 9.45 to 25.01 μg/L. In addition to the acute toxicity bioassay experiments, 24-h oxidative stress parameters such as malondialdehyde (MDA) levels and ferrous oxidation assay (FOX HP [hydrogen peroxide] equivalents) were also determined. Only MDA levels of hepatopancreas decreased at 5, 10, and 20 μg/L of fenitrothion doses. We can conclude that fenitrothion is highly toxic to crayfish, a nontarget organism in the ecosystem, and the lipid peroxidation indicators can be easily used for monitoring environmental effects.     

Highlighting Levels of Indoxyl Sulphate among Critically Ill Patients with Acute Nephrotoxicity; Correlations Between Indoxyl Sulphate Levels and Patients’ Characteristics

Background:Many animal studies suggested that the uremic toxin indoxyl sulphate can add to renal damage following induced nephrotoxicity and this effect has not been proved in patients with such complication. Methods:This is a prospective, case-control, and an observational study conducted on 74 critically ill patients with acute nephrotoxicity. It was designed to measure serum levels of indoxyl sulphate on the day of enrollment and over the course of their illness using high performance liquid chromatography (HPLC-UV) and to test the correlation between these levels and patient’s demographics, clinical characteristics, physiological variables, and their outcomes.Results:Critically ill patients with acute nephrotoxicity had significantly higher total (tIS) and free (fIS) indoxyl sulphate than healthy controls and significantly lower than patients with end-stage renal disease (ESRD). Although, no correlation was found between tIS or fIS and mortality, among survivors, tIS, fIS, creatinine and eGFR were independently associated with no renal recovery.Conclusion:Serum indoxyl sulphate levels were elevated in critically ill patients with acute nephrotoxicity. There is an association between high levels of indoxyl sulphate and no renal-recovery outcome among survivors of acute nephrotoxicity. Early removal of indoxyl sulphate from patients’ blood may improve their outcomes.Key Words: HPLC, Indoxyl sulphate, Mortality, Prognosis, Toxic acute kidney injury     

Effectiveness of skin-heating using a water-perfused suit as passive and post-exercise heat acclimation strategies

The purpose of the present study was to evaluate the effectiveness of passive and post-exercise heat acclimation strategies through directly heating the skin with a water-perfused suit. Nineteen young males participated in the heat acclimation (HA) protocols for 10 days, which were conducted at an air temperature of 33^oC with 60%RH. The exercise-only condition (N = 6) conducted 1-h treadmill walking (6 km·h^-1) followed by 1-h rest. The post-exercise passive-heating condition (N = 6) wore the suit (inflow water temperature 44.2^oC) for 1-h after 1-h walking. The passive-heating condition (N = 7) donned the suit for 2 h. Heat tolerance tests (leg immersion in 42^oC water for 60 min) were conducted before and after the training to evaluate changes due to the 10-day intervention. Reflecting that suit-wearing for 10 days as both passive and post-exercise HA strategies can effectively induce adaptive changes, significant interaction effects appeared in: increase or decrease in mean skin temperature (P < 0.05) and elevation in whole-body sweat rate (P < 0.05). Reduction in rectal temperature (P < 0.05) and blood pressure (P < 0.05) were found most prominently in the passive-heating condition. These results indicate that this new method of heat acclimation training, donning a skin-heating water-perfused suit, can generate thermoregulatory benefits. The passive HA intervention could be applied to individuals for whom doing exercise regularly are not feasible.     

Acute toxicity of Amanranthus viridus extract on guppies, Poecilia reticulata

Many Thai plant species shows the responsible for controlling insects from the host plants. To avoid potential toxic pollutant contaminating aquatic ecosystems, this present study was investigated for acute toxicity from Amaranthus viridis to Guppy fish (Poecilia reticulata) were selected for the bioassay experiments. The experiments were repeated 5 times and the 1-, 3- and 24-h LC50 was determined for the guppies. The acute toxicity experiments were carried out by static method and behavioral changes in guppies were determined for Amaranthus viridis concentration extract which extracted by Soxhlet's extraction method with ethanol as solvent. Water temperature was regulated at 20 +/- 1 degrees C. Data obtained from the acute toxicity tests were evaluated using the Probit analysis statistical method. The 24-h LC50 value for guppy was estimated as ca. 947 mg L(-1) (r2 = 0.95). However, in this concentration, no mortality was observed at higher concentration for 30 second.     

Prediction of all-cause mortality with hypoalbuminemia in patients with heart failure: a meta-analysis

Abstract

Objective: The prognostic utility of serum albumin level for mortality in heart failure patients has received considerable attention. This meta-analysis sought to examine the prognostic significance of hypoalbuminemia for prediction of all-cause mortality in patients with heart failure.

Materials and methods: Pubmed and Embase databases were systematically searched up to 10 March 2019 to identify eligible studies. Epidemiological studies reporting a multivariable-adjusted risk estimate of all-cause mortality associated with hypoalbuminemia in acute or chronic heart failure patients were included.

Results: Nine studies from 10 articles involving 16,763 heart failure patients were included in the final analysis. Hypoalbuminemia was associated with an increased in-hospital mortality (risk ratio [RR] 4.90; 95% confidence interval [CI] 2.96–8.10) and long-term all-cause mortality (RR 1.75; 95% CI 1.35–2.27) in acute heart failure patients. Chronic heart failure patients with hypoalbuminemia exhibited a 3.5-fold (95% CI 1.29–9.73) higher risk for long-term all-cause mortality.

Conclusions: Hypoalbuminemia is possibly an independent predictor of all-cause mortality in patients with acute or chronic heart failure. However, the current findings should be further confirmed in future prospective studies. Moreover, future well-designed randomized controlled trials would be required to investigate whether correcting hypoalbuminemia in heart failure patients has potential to improve survival outcome.