ADMISSION SERUM ALBUMIN IS ASSOCIATED WITH HOSPITAL-ACQUIRED VTE IN A COHORT OF SOLDIERS WOUNDED IN OPERATION ENDURING FREEDOM AND OPERATION IRAQI FREEDOM

Abstract

SESSION TITLE: Pulmonary Vascular Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Define the association between serum albumin and in-hospital venous thromboembolism (VTE) and compare the differences between patients wounded in Afghanistan (OEF) and Iraq (OIF) and the general hospital population. METHODS: We conducted a prospective, observational study of patients admitted to the Walter Reed Army Medical Center (WRAMC) between September 2009 and March of 2011. The primary outcome was in-hospital VTE events. Daily data abstraction was performed for each admission, to include patient characteristics, percentage time on thromboprophylaxis, and measurements of laboratory values, including serum albumin. RESULTS: There were 6559 adult patients admitted for more than two days during this period. A total of 160 VTE events were observed, with incidences of 2.42% and 4.89% for all admissions and trauma due to deployment related war injuries respectively. At least one serum albumin was measured in 66.3% of admissions. Overall, despite high adherence to chemical prophylaxis, compared to a serum albumin of 3.5-4.5 mg/dL, an initial albumin of less than 2.5 mg/dL was associated an increased risk of VTE, hazard ratio 6.3 (95% CI 3.7-10.7, p value <0.001). The relationship between serum albumin was particularly evident in those with deployment-related injuries (HR 20.4, 2.8- 149.0, p value = 0.003). In multivariate cox regression, serum albumin was independently associated with in-hospital VTE. CONCLUSIONS: Patients with a low admission serum albumin were more than six times as likely to have an in-hospital VTE. The effect size was even greater among wounded soldiers returning from OEF and OIF. This association likely highlights serum albumin as a negative acute phase reactant and as a marker of a pro-inflammatory and hyper-coagulable state. Further research is needed to fully explain this association and how it may be utilized to predict and prevent in-hospital VTE. CLINICAL IMPLICATIONS: Hypoalbuminemia was associated in-hospital VTE risk and while this has been recognized in other subgroups (e.g. subjects with cancer and nephrotic syndrome), it has not been observed in the individualized with severe traumatic injuries. Knowledge of this risk factor, may improve our ability to prevent VTE in this population. DISCLOSURES: My spouse/partner as a Employee relationship with United Health Group Please note: $20001 - $100000 by Aaron Holley, source=Web Response, value=stock options Provided educational content on nebulized tiotropium relationship with CHEST Please note: approximately 4 months (Jan-Apr 2019) Added 04/30/2020 by Aaron Holley, source=Web Response, value=Honoraria Write pieces on journal articles to be published online relationship with WebMD Please note: 5 years Added 04/30/2020 by Aaron Holley, source=Web Response, value=Consulting fee Agreed to design COPD web and game-based educational content relationship with CHEST Please note: Hasn't started yet, will occur this Spring Added 04/30/2020 by Aaron Holley, source=Web Response, value=Honoraria No relevant relationships by Michael McMahon, source=Web Response