Association and Discriminative Performance of a Bilirubin-D-Dimer-Albumin Index for LVEF <45% in Patients with Heart Failure: A Single-Centre Retrospective Study.
- 1Department of Cardiology, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, People's Republic of China.
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 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
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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BibTeX
@article{rafiq2026association,
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.}},
author = {Shiraz Rafiq and Jannat Atajanova and He Pengyi},
journal = {Vascular health and risk management},
year = {2026},
month = oct,
doi = {10.2147/vhrm.s638204},
url = {https://europepmc.org/article/MED/42948664},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Association and Discriminative Performance of a Bilirubin-D-Dimer-Albumin Index for LVEF <45% in Patients with Heart Failure: A Single-Centre Retrospective Study.
AU - Shiraz Rafiq
AU - Jannat Atajanova
AU - He Pengyi
PY - 2026
DA - 2026/10/23
JO - Vascular health and risk management
DO - 10.2147/vhrm.s638204
UR - https://europepmc.org/article/MED/42948664
AB - 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 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 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.
SN - 1176-6344
SN - 1178-2048
ER -