Epidemiology of Hypoalbuminemia in Hospitalized Patients: A Clinical Matter or an Emerging Public Health Problem?

Stefania Moramarco,Fausto Ciccacci,Paola Gualtieri,Leonardo Palombi,Luca Morucci,Mario Messinese,Antonino De Lorenzo,Laura Morciano,Stefano Orlando,Ersilia Buonomo,Jacopo Maria Legramante,Mariachiara Carestia

doi:10.3390/nu12123656

Abstract

Serum albumin levels are strongly associated with the morbidity, prognosis, and mortality rates of patients with hypoalbuminemia, which is a frequent problem during hospitalization. An observational retrospective study was carried out to analyze changes in albumin levels in hospitalized patients at the “Fondazione Policlinico Tor Vergata—PTV” in 2018. The prevalence of preexisting hypoalbuminemia at the time of discharge from hospital was investigated using a sample of 9428 patients. Information was collected from the discharge files recorded in the central informatics system of the hospital. Analysis of albumin levels at admission and at discharge was conducted by classes of albuminemia and then stratified by age. At the time of admission, hypoalbuminemia was found to be present in more than half of the sample, with no sex differences. The serum albumin level tended to decrease with age, with pathologic levels appearing from 50 years and progressive worsening thereafter. The condition of marked and mild hypoalbuminemia was more prevalent in patients over 65 years of age. Our findings suggest that hypoalbuminemia should be considered a dangerous condition in itself and a serious public health problem. We aimed to emphasize the role of albumin as useful marker of the in-hospital malnutrition and frailty, to be integrated in the routinely assessment of patients for reconsidering ad hoc healthcare pathways after discharge from hospital, especially when dealing with fragile populations.

Highlights

Human serum albumin is an important parameter for the routine assessment of the nutritional status of patients with acute and chronic conditions [1]
The socio-demographic analysis revealed that the serum albumin level was significantly lower in patients who were less educated, with illiterate patients or those having primary or intermediate education presenting hypoalbuminemia
Albumin can be considered as a low-cost marker to stratify patients by risk during hospitalization and as an indicator that, combined with a more exhaustive nutrition evaluation as a best practice, can support decision makers to prescribe nutritional support even after discharging

Summary

Introduction

Human serum albumin is an important parameter for the routine assessment of the nutritional status of patients with acute and chronic conditions [1]. Albumin is associated with diseases related to the control of glycemia and adipose tissue [7,8]. Hypoalbuminemia [9] is commonly discovered in association with nutritional deterioration and disease-related inflammatory response [10]. The relationship between hypoalbuminemia and age has not been fully elucidated; the association should take into account diseases and other age-related conditions rather than age alone [12]

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