ALB and nutritional deficiency disease: Albumin is a hepatic synthesized protein that is associated with numerous detrimental biological processes that are present in HF and pertain to a worse outcome.9 Low albumin in HF patients may be due to volume overload causing hemodilution, a chronic inflammatory state, liver congestion, malnutrition and cachexia, all causing decreased synthesis of albumin, and less commonly, protein loss due to proteinuria or enteropathy.