{
  "abstract": "Background\n\nAccurate 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\n\nIn 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\n\nThe 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 χ²=73.44, df=1, P<0.001) and increased the AUC from 0.873 to 0.934. Internal validation yielded an optimism-adjusted AUC of 0.908, while 10-fold cross-validation yielded a mean AUC of 0.901. DCA showed greater estimated net benefit for the model incorporating the BDA Index across threshold probabilities of 5%-80%.Conclusion\n\nIn 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.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Cardiology, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, People's Republic of China."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 3,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Shiraz Rafiq",
      "orcid": "0009-0007-4756-4427"
    },
    {
      "affs": [
        0
      ],
      "name": "Jannat Atajanova"
    },
    {
      "affs": [
        0
      ],
      "name": "He Pengyi"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/f5brny6zvzyva.bib",
  "cited_by": 0,
  "doi": "10.2147/vhrm.s638204",
  "fulltext_url": "https://europepmc.org/articles/PMC13712150",
  "id": "f5brny6zvzyva",
  "issns": [
    "1176-6344",
    "1178-2048"
  ],
  "landing_url": "https://europepmc.org/article/MED/42948664",
  "language": "eng",
  "licence": "CC-BY-NC",
  "licence_label": "CC BY-NC",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Research"
    ],
    [
      "openalex",
      "2705|Heart Failure Treatment and Management"
    ]
  ],
  "openalex": "W7223201842",
  "pdf_url": "https://europepmc.org/articles/PMC13712150?pdf=render",
  "pmcid": "PMC13712150",
  "pmid": "42948664",
  "published": "2026-10-23",
  "publisher": "Dove Press",
  "ris": "https://research.draconitic.com/paper/f5brny6zvzyva.ris",
  "sources": [
    {
      "first_seen": "2026-10-31T00:20:34Z",
      "native_id": "MED:42948664",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42948664"
    },
    {
      "first_seen": "2026-10-31T12:22:47Z",
      "native_id": "PMC13712150",
      "source": "pmc",
      "url": "https://doi.org/10.2147/vhrm.s638204"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2705|Heart Failure Treatment and Management",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Association and Discriminative Performance of a Bilirubin-D-Dimer-Albumin Index for LVEF <45% in Patients with Heart Failure: A Single-Centre Retrospective Study.",
  "title_text": "Association and Discriminative Performance of a Bilirubin-D-Dimer-Albumin Index for LVEF <45% in Patients with Heart Failure: A Single-Centre Retrospective Study.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-31T12:22:47Z",
  "url": "https://research.draconitic.com/paper/f5brny6zvzyva",
  "venue": "Vascular health and risk management",
  "versions": []
}