Incidence and risk factors for low serum albumin concentrations in neonates evaluated for jaundice.

BackgroundTo investigate the relationship between preoperative low serum albumin and perioperative blood transfusion in patients undergoing total joint arthroplasty (TJA).MethodsWe enrolled 2,772 TJA patients from our hospital between January 1, 2017, and January 1, 2022. Clinical data were extracted from electronic medical records, including patient ID, sex, BMI (Body Mass Index), age, and diagnoses. Receiver operating characteristic curves were constructed to establish thresholds for serum albumin levels categorization. Propensity score matching (PSM) was developed with preoperative serum albumin as the dependent variable and perioperative blood transfusion-related factors as covariates, including BMI grade, age grade, sex, diagnosis, hypertension, diabetes, coronary heart disease, chronic obstructive pulmonary disease, chronic bronchitis, cerebral infarction, major surgeries within the last 12 months, renal failure, cancer, depression, corticosteroid use, smoking, drinking, and blood type. The low serum albumin group was matched with the normal albumin group at a 1:2 ratio, employing a caliper value of 0.2. Binary logistic regression was employed to analyze the outcomes.ResultsAn under the curve of 0.601 was discovered, indicating a cutoff value of 37.3 g/L. Following PSM, 892 cases were successfully paired in the low serum (< 37.3 g/L) albumin group, and 1,401 cases were matched in the normal serum albumin (≥ 37.3 g/L) group. Binary logistic regression in TJA patients showed that the albumin OR was 0.911 with 95%CI 0.888–0.935, P < 0.001. Relative to the preoperative normal serum albumin group, TJA patients in the low serum albumin group experienced a 1.83-fold increase in perioperative blood transfusion rates (95% CI 1.50–2.23, P < 0.001). Compared to the normal serum albumin group, perioperative blood transfusion rates for TJA patients with serum albumin levels of 30–37.3 g/L, 25–30 g/L, and ≤ 25 g/L increased by 1.63 (95% CI 1.37–1.99, P < 0.001), 5.4 (95% CI 3.08–9.50, P < 0.001), and 6.43 times (95% CI 1.80-22.96, P = 0.004), respectively.ConclusionIn TJA patients, preoperative low serum albumin levels have been found to be associated with an increased risk of perioperative blood transfusion. Furthermore, it has been observed that the lower the preoperative serum albumin level is, the higher the risk of perioperative blood transfusion.Trial registration28/12/2021, Chinese Clinical Trial Registry, ChiCRT2100054844.

Impact of hypoalbuminemia on in-hospital mortality in patients with takotsubo syndrome: A multicenter registry of the Tokyo Cardiovascular Care Unit Network

Objective To investigate the correlation between hypoalbuminemia and heart failure with preserved ejection fraction (HFpEF) and to analyze the prognosis of patients with HFpEF and hypoalbuminemia. Methods Three hundred and fourteen patients with HFpEF who were hospitalized in Department of Cardiology, Shengjing Hospital of China Medical University from January 2012 to December 2013 were analyzed retrospectively. These patients were divided into two groups according to the serum albumin, hypoalbuminemia (< 35g/L) group and normal albumin group (≥ 35g/L). The prognostic correlation between hypoalbuminemia and HFpEF was analyzed by COX regression analysis. Results Patients with hypoalbuminemia had a higher mortality: 20.2%(20/99) vs. 9.8%(21/215). There was no significant difference in the average hospitalization time、hospital mortality and readmissions for heart failure between two groups. Univariate COX regression analysis showed that the relative risk ratio of readmissions between normal albumin group and hypoalbuminemia group was 0.554(0.374-0.820), and the relative risk ratio of cardiogenic death was 0.283(0.148-0.538), P < 0.05. Conclusions HFpEF patients with hypoalbuminemia have relative poor heart function; hypoalbuminemia may be a risk factor of cardiac death for patients with HFpEF. Key words: Hypoproteinemia; Heart failure; Preserve ejection fraction

Objective To explore the relationship between different serum albumin and lymphocyte levels in patients with 2019-novel coronavirus (2019-nCoV) pneumonia (COVID-19). Methods A retrospective study was performed to identify the characteristics of the clinical data of 205 COVID-19 patients who were hospitalized in the Happy Street of Hanchuan People's Hospital, Xiaogan, Hubei Province from January 24 to February 12, 2020, including their general information, serum albumin (ALB) levels, lymphocyte counts (LYM), percentage of lymphocytes (LYM%) and other laboratory parameter levels. Low ALB group and normal ALB group were demarcated by the concentration of 35g/L, further to identify the differences of LYM and LYM% levels and the incidence of LYM and LYM% decline at different ALB levels between groups,as well as the correlation between ALB and LYM, LYM% levels in hypoalbuminemia conditions . Results 17.5% of COVID-19 patients were associated with hypoalbuminemia. The levels of LYM and LYM% in the low ALB group were significantly lower than those in the normal ALB group (P <0.001). The incidence of LYM and LYM% decline in the low ALB group was significantly higher than those in the normal ALB group (P <0.001). The levels of LYM and LYM% in the low ALB group were significantly positively correlated with serum ALB concentrations (P <0.05). Conclusions The decrease of lymphocyte levels in COVID-19 patients may be correlated to hypoalbuminemia. COVID-19 patients complicated by hypoalbuminemia should be actively intervened to maintain serum albumin in the normal range. Key words: Novel coronavirus; COVID-19; Albumins; Hypoalbuminemia; Infectious diseases; Lymphocyte count; Inflammatory factor; Treatment, integration

To study whether hypoalbuminemia after pediatric cardiopulmonary bypass (CPB) for cardiac surgery is a risk factor for postoperative acute kidney injury (AKI). A retrospective analysis was performed on the clinical data of 1 110 children who underwent CPB surgery between 2012 and 2016. According to the minimum serum albumin within 48 hours postoperatively, these patients were divided into hypoalbuminemia group (≤35 g/L) and normal albumin group (>35 g/L). The two groups were compared in terms of perioperative data and the incidence of AKI. Furthermore, the incidence of AKI was compared again after propensity score matching for the unbalanced factors during the perioperative period. The perioperative risk factors for postoperative AKI were analyzed by logistic regression. The overall incidence rate of postoperative AKI was 13.78% (153/1 110), and the mortality rate was 2.52% (28/1 110). The mortality rate of children with AKI was 13.1% (20/153). The patients with hypoalbuminemia after surgery (≤35 g/L) accounted for 44.50% (494/1 110). Before and after propensity score matching, the hypoalbuminemia group had a significantly higher incidence of AKI than the normal albumin group (P<0.05). The children with AKI had a significantly lower serum albumin level after surgery than those without AKI (P<0.05). The multivariate logistic regression analysis showed albumin ≤35 g/L was one of the independent risk factors for postoperative AKI. Albumin ≤35 g/L within 48 hours postoperatively is an independent risk factor for postoperative AKI in children after CPB surgery.

BackgroundThe optimal levels of low-density lipoprotein cholesterol (LDL-C) in patients with type 2 diabetes (T2D) are not currently clear. In this study, we determined the relationship between various mean LDL-C and all-cause or cardiovascular mortality risks in patients with T2D, stratifying by albumin level, age, sex, and antilipid medication use. We also evaluated the association of LDL-C standard deviation (LDL-C-SD) and all-cause and cardiovascular mortality by type of antilipid medication use.MethodsA total of 46,675 T2D patients with a prescription for antidiabetic agents >6 months from outpatient visits (2003–2018) were linked to Taiwan’s National Death Registry to identify all-cause and cardiovascular mortality. The Poisson assumption was used to estimate mortality rates, and the Cox proportional hazard regression model was used to assess the relative hazards of respective mortality in relation to mean LDL-C in patient cohorts by albumin level, age, sex, and antilipid use adjusting for medications, comorbidities, and laboratory results. We also determined the overall, and anti-lipid-specific mortality rates and relative hazards of all-cause and cardiovascular mortality associated with LDL-C-SD using the Poisson assumption and Cox proportional hazard regression model, respectively.ResultsAll-cause and cardiovascular mortality rates were the lowest in T2D patients with a mean LDL-C > 90-103.59 mg/dL in the normal albumin group (≥ 3.5 g/dL). Compared to T2D patients with a mean LDL-C > 90–103.59 mg/dL, those with a mean LDL-C ≤ 77 mg/dL had an elevated risk of all-cause mortality in both the normal and lower albumin groups. T2D patients with a mean LDL-C ≤ 90 and > 103.59–119 mg/dL had relatively higher risk of cardiovascular mortality in the normal albumin group, but in the lower albumin group (<3.5 g/dL), any level of mean LDL-C ≤ 119 mg/dL was not significantly associated with cardiovascular mortality. Increased risks of all-cause and cardiovascular mortality were observed in patients with a mean LDL-C ≤ 77 mg/dL in both sexes and in all age groups except in those aged <50 years, a lower mean LDL-C was not associated with cardiovascular mortality. Similarly, patients with an LDL-C-SD <10th and > 90th percentiles were associated with significant risks of all-cause and cardiovascular mortality. In statin users, but not fibrate users, lower and higher levels of mean LDL-C and LDL-C-SD were both associated with elevated risks of all-cause and cardiovascular mortality.ConclusionsThe optimal level of LDL-C was found to be >90–103.59 mg/dL in T2D patients. Lower and higher levels of mean LDL-C and LDL-C-SD were associated with all-cause and cardiovascular mortality, revealing U-shaped associations. Further studies are necessary to validate the relationship between optimal LDL-C levels and all-cause and cardiovascular mortality in patients with diabetes.

Introduction It is well known that hypoalbuminemia is associated with adverse outcomes in various critical illnesses. However, there are few studies specifically measuring the association between albumin level and neurologic outcomes after CA treated with TTM. The aim of this study was to assess whether serum albumin concentration on admission had prognostic value for OHCA patients treated with TTM. Methods We included adult patients aged ≥18 years with nontraumatic OHCA treated with TTM whose serum albumin concentration was available and who were admitted from 2009 to 2016. Serum albumin was measured within 1 h after ROSC, and hypoalbuminemia was defined as admission serum albumin <3.5 g/dl. A good neurologic outcome was defined as a cerebral performance category score of 1 or 2 at 6 months. Results A total of 255 patients were eligible for analysis, of whom 106 (41.6%) survived to 6 months; 84 (32.9%) of these patients achieved favorable neurologic outcomes. The mean albumin values were significantly lower in patients with poor neurologic outcomes than the values in those with good neurologic outcomes (3.3 ± 0.6 vs. 3.9 ± 0.4, respectively, p < 0.001). After adjusting the crude model, patients in the hypoalbuminemia group were 3.5 times more likely to have poor neurologic outcome than were those in the normal albumin group (OR 3.526, 95% CI 1.388–8.956, p=0.008). Conclusions Hypoalbuminemia was common after CA, and the serum albumin level at admission was associated with poor neurological outcomes at 6 months after CA in patients treated with TTM.

Association of low serum albumin concentration and adverse cardiovascular events in stable coronary heart disease

Expert consensus on the use of human serum albumin in critically ill patients.

Background: Coronavirus disease 2019 (COVID-19) can cause serious complications such as multiorgan failure and death which are difficult to predict. We conducted this retrospective case-control observational study with the hypothesis that low serum albumin at presentation can predict serious outcomes in COVID-19 infection. Methods: We included severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcriptase-polymerase chain reaction (RT-PCR) confirmed, hospitalized patients from March to July 2020 in a tertiary care hospital in the USA. Patients were followed for 21 days for the development of the primary endpoint defined as the composite outcome which included acute encephalopathy, acute kidney injury, the requirement of new renal replacement therapy, acute hypercoagulability, acute circulatory failure, new-onset heart failure, acute cardiac injury, acute arrhythmia, acute respiratory distress syndrome (ARDS), high flow oxygen support, intensive care unit (ICU) stay, mechanical ventilation or death; and the secondary endpoint of death only. Univariate and multivariate logistic regression analyses were performed to study the effect of albumin level and outcomes. Results: The mean age was 56.76 years vs. 55.67 years (P = 0.68) in the normal albumin vs. the low albumin group. We noticed an inverse relationship between serum albumin at presentation and serious outcomes. The low albumin group had a higher composite outcome (93.88% vs. 6.12%, P < 0.05) and higher mortality (13.87% vs. 2.38%, P < 0.05) in comparison to the normal albumin group. The multivariate logistic regression analysis revealed higher odds of having composite outcomes with lower albumin group (odds ratio (OR) 10.88, 95% confidence interval (CI) 4.74 - 24.97, P < 0.05). In the subgroup analysis, the multivariate logistic regression analysis revealed higher odds of having composite outcomes with the very low albumin group (OR 7.94, 95% CI 1.70 - 37.14, P < 0.05). Conclusions: Low serum albumin on presentation in COVID-19 infection is associated with serious outcomes not limited to mortality. The therapeutic option of albumin infusion should be investigated. J Clin Med Res. 2021;13(5):258-267 doi: https://doi.org/10.14740/jocmr4507

Serum Albumin As a Prognostic Factor for Overall Survival at 6-Months in Acute Myeloid Leukemia (AML)

Impact of Serum Albumin on Functional Status and Hospital Outcome in Oldest-Old Inpatients

PurposeThe purpose of our study was to investigate the effect of pre-operative hypoalbuminemia on the short-term outcomes after primary colorectal cancer (CRC) surgery.Materials and methodsThe retrospective study enrolled CRC patients who underwent primary surgery from January 2011 to December 2021 in a single teaching hospital. The short-term outcomes were compared between the hypoalbuminemia group and the normal group using propensity score matching (PSM). Univariate and multivariate logistic regression analyses were used for analyzing independent predictors of overall complications and major complications.ResultsA total of 7,072 patients from a single center were enrolled in this study. There were 1,078 (15.2%) patients in the pre-operative hypoalbuminemia group and 5,994 (84.8%) patients in the normal pre-operative albumin group. After 1:1 PSM, there were 1,028 patients in the hypoalbuminemia group and 1,028 patients in the normal group. No significant differences were found in baseline information between the two groups after PSM. In terms of short-term outcomes, the hypoalbuminemia group had a longer operation time (p = 0.003), greater volume of blood loss (p = 0.036), longer hospital stays (p < 0.01), higher proportion of overall complications (p = 0.003), major complications (p = 0.016), higher incidence of pneumonia and abdominal infection (p = 0.001) than the normal group after PSM. Furthermore, hypoalbuminemia was an independent predictor for overall complications (p = 0.008) and major complications (p = 0.016).ConclusionPre-operative hypoalbuminemia increased overall complications and major complications after primary CRC surgery. Furthermore, hypoalbuminemia was an independent predictor for overall complications and major complications.

6586 Background: Hypoalbuminemia (HA) is an adverse prognostic factor in multiple neoplastic diseases. Severe hypoalbuminemia (&lt;3.0 g/dl) at day +90 post allogeneic hematopoietic cell transplant (AHCT) was reported as an independent predictive variable for non-relapse mortality and overall survival (Kharfan-Dabaja, et al Biol Blood Marrow Transplant 2009; 15). We examined the prognostic value of serum albumin level prior to induction chemotherapy in patients with newly diagnosed AML. Methods: Data were collected retrospectively in newly diagnosed AML patients receiving induction chemotherapy (3+ 7 regimen). Primary objective was to examine the relationship between serum albumin at baseline and probability of achieving complete remission (CR) or incomplete remission (CRi) and overall survival (OS). The Kaplan–Meier method used to estimate median overall survival; chi-square test used for comparison of categorical variables and t-test for continuous variables. Log rank test used to compare Kaplan–Meier survival estimates between two groups. Results: Between November 2004 to July 2007, 135 patients who received 3+7 induction chemotherapy were included. Patient baseline characteristics were similar between patients with serum albumin &lt; 3.5 g/dl (HA) and those with serum albumin ≥ 3.5 g/dl (no HA) with respect to age, sex, FAB subtype, history of antecedent MDS, karyotype, and chemotherapy . In patients with HA, mean age was 60 years compared to 56.5 years in non HA group. The median OS for patients with HA was 221 days (95%CI 149.5-292.5) compared to 421 days (95%CI 236.7-605) with normal serum albumin (p&lt;0.005). (Figure-1) The CR/CRi rate was 64%% for HA and 77.6% for those with normal albumin (p=0.09). In a multivariable Cox regression analysis including age ≥ 60 years, history of MDS, karyotype, and serum albumin level at baseline; only age, karyotype and serum albumin were independent predictors of OS [Hazard ratio 0.47 (95%CI 0.31-0.71) (p&lt;0.005) for normal serum albumin group]. Conclusions: In newly diagnosed AML, we demonstrate that hypoalbuminemia &lt; 3.5 g/dl is an independent covariate for overall survival with conventional chemotherapy management. The prognostic value of low serum albumin should be validated in a prospective study.

Objective To evaluate the clinicopathologic characteristics and prognosis of gastric stump cancer in relation to serum albumin level. Methods The clinical data of 149 gastric stump cancer patients treated from Jan 1999 to Jun 2015 were analyzed. Patients were divided into normal serum albumin group (>35 g/L, n=81) and group of hypoalbuminemia (≤35 g/L, n=68). Results Clinicopathologic characteristics, tumor size, depth of invasion, lymph node status and TNM stage were significantly different between the two groups (P<0.05). Univariate analysis showed that factors that influence prognosis were serum albumin level, tumor size, serosal invasion, tumor location and tumor curative resection rate (all P<0.05). Cox′s proportional hazard regression model showed that serum albumin level and tumor curative resection rate were independent prognostic factors for survival, lymph node matastasis(2.2±4.3) vs. (4.1±4.4)were significantly different between the two groups (P<0.05). The overall 5-year survival rate was 44.1%. The 5-year survival rate were 54.0% for normal albumin group and 32.2% for hypoalbuminemic group, P=0.011. Conclusion Lower preoperative serum albumin level is associated with poorer prognosis in gastric stump cancer patients. Key words: Stomach neoplasms; Serum albumin; Pathology, clinical; Prognosis