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. This evidence concerns the gene ALB and hydrops fetalis.