In this single-centre retrospective cohort of 338 heart failure patients, the bilirubin-D-dimer-albumin (BDA) Index showed good discriminatory performance for identifying LVEF <45% and provided additional information beyond NT-proBNP and other clinical and laboratory variables, though prospective multicentre studies with external validation are needed.
The BDA Index was significantly higher in heart failure patients with LVEF <45% than in those with LVEF ≥45%.
The BDA Index discriminated LVEF <45% significantly better than NT-proBNP.
At the Youden-derived cutoff of 0.435, the BDA Index had high sensitivity and moderate-to-good specificity for LVEF <45%.
The BDA Index was independently associated with LVEF <45% after multivariable adjustment.
Adding the BDA Index to a clinical and laboratory model significantly improved model fit and discrimination.
Internal validation supported the discriminative performance of the BDA Index-containing model with little evidence of optimism.
Decision curve analysis showed greater estimated net benefit for the model incorporating the BDA Index across a wide range of threshold probabilities.
The authors conclude the BDA Index provides information beyond NT-proBNP but that external validation is required before clinical use.
This study looked at whether a simple score built from three routine blood tests—bilirubin, D-dimer, and albumin—could help identify heart failure patients whose hearts pump weakly (a left ventricular ejection fraction below 45%). The researchers reviewed records of 338 heart failure patients at one hospital, 149 of whom had reduced pumping function. They compared the new score, called the BDA Index, with NT-proBNP, a commonly used heart failure blood marker. The BDA Index was higher in patients with weaker heart pumping and distinguished them from other patients better than NT-proBNP did (AUC 0.902 vs 0.773). At the chosen cutoff it correctly flagged about 88% of patients with reduced function and correctly cleared about 78% of those without. It remained associated with reduced pumping function after accounting for other clinical and lab factors, and adding it to a prediction model improved the model's performance. Internal checks on the same dataset gave similar results, suggesting the findings were not simply due to chance fitting. This research suggests the BDA Index may be a useful additional tool, but the findings come from one hospital and a retrospective review, and haven't been tested in separate patient groups. The authors note that prospective, multicentre studies with independent validation are needed before it can be considered for routine use.
Rafiq S, Atajanova J, Pengyi H. (2026). Association and Discriminative Performance of a Bilirubin-D-Dimer-Albumin Index for LVEF <45% in Patients with Heart Failure: A Single-Centre Retrospective Study.. Vascular health and risk management. https://doi.org/10.2147/VHRM.S638204