Association between Pre-Albumin and Malnutrition in Children with Advanced Heart Failure

Abstract

<h3>Purpose</h3> Malnutrition is an important complication of heart failure (HF) and associated with significant mortality. The serum pre-albumin level is often performed to evaluate patient nutritional status in HF, however its association with clinical malnutrition severity has not been determined. We sought to evaluate the association between pre-albumin and malnutrition severity using contemporary definitions of malnutrition. <h3>Methods</h3> All children listed for heart transplant (HT) between 2014 and 2017 were identified using a hospital database at a single center. Clinical malnutrition severity was determined by a certified pediatric dietitian using the American Society of Parenteral and Enteral Nutrition (ASPEN) guidelines. The pre-albumin level drawn around the time of the nutritional assessment was recorded. ANOVA for K groups with the Bonferroni correction was used to compare groups. <h3>Results</h3> Among 73 children who met the inclusion criteria, the median age at nutrition evaluation was 7.8 (Q1-Q3 1.3-12.6) years, the median weight-for-age Z-score was -1.5 (-2.3, 0.1), 36% were female, and 68% had congenital heart disease. Overall, malnutrition status by ASPEN guidelines was mild (25%), moderate (30%), severe (21%), or normal or obese (24%). Among the 73 subjects, the mean pre-albumin level was 20 (SD 10) mg/dl including 50% classified as normal. By ANOVA, there was no association between pre-albumin and clinical nutrition severity in children with HF (<b>Figure).</b> Variation within individual patients was high. <h3>Conclusion</h3> Pre-albumin does not appear to be a meaningful marker of malnutrition status in children with advanced heart failure. Pre-albumin levels vary markedly across malnutrition groups and within individual patients at a constant nutrition status, variability which may reflect its tendency to rise and fall as an acute phase reactant. Alternative strategies for estimating nutritional status are warranted.