Abstract
BackgroundSerum albumin is a marker of nourishment and inflammation. Although hypoalbuminemia in hemodialysis patients is reported as a risk factor for poor prognosis, few studies describe its effects on infectious diseases specifically. This study aimed to examine the relationship between the serum albumin level on admission and infection-related in-hospital death among hemodialysis patients.MethodsThis was a multicenter retrospective observational study that was undertaken in Japan. We reviewed the medical records of 507 hemodialysis patients aged > 18 years, whose blood cultures were obtained based on suspicion of infectious disease, and who were managed at seven Japanese tertiary dialysis units from August 2011 to July 2013. The outcome measure was infection-related in-hospital death. Multivariate logistic regression models adjusted for age, sex, the dialysis vintage, diabetes mellitus, bacteremia, and log C-reactive protein levels were used for the statistical analysis.ResultsFour hundred patients were analyzed and allocated to three groups based on their serum albumin levels: marked hypoalbuminemia (< 2.5 mg/dL), mild hypoalbuminemia (≤ 2.5–< 3.5 mg/dL), and normal albumin levels (≤ 3.5 mg/dL). The infection-related in-hospital death rates were 22.9% (n = 11), 12.5% (n = 25), and 4.6% (n = 7), respectively. The multivariate logistic regression models determined that a low serum albumin level was an independent risk factor for infection-related in-hospital death (odds ratio 0.35, 95% confidence interval 0.18–0.66).ConclusionsA low serum albumin level strongly predicts infection-related in-hospital death in hemodialysis patients hospitalized on suspicion of infection. Like those with bacteremia or diabetes mellitus, hemodialysis patients with hypoalbuminemia require careful management of their infections.
Highlights
Serum albumin is a marker of nourishment and inflammation
We reviewed the medical records of consecutive hemodialysis patients who were over 18 years of age and from whom blood cultures were obtained at least twice based on the suspicion of infectious disease in an outpatient setting or within 48 h after admission
Baseline characteristics A total of 507 hemodialysis patients were included in this study, and 400 patients were analyzed after excluding the patients who were not hospitalized and those whose serum albumin data were missing (Fig. 1)
Summary
Hypoalbuminemia in hemodialysis patients is reported as a risk factor for poor prognosis, few studies describe its effects on infectious diseases . This study aimed to examine the relationship between the serum albumin level on admission and infection-related in-hospital death among hemodialysis patients. Reports from previous studies have described diabetes, cancer, multisystem disease, vascular access type, serum albumin level, and being female as risk factors for infection-related mortality in patients who undergo renal replacement therapy [1, 7,8,9]. Hypoalbuminemia in hemodialysis patients has been described as a risk factor for poor prognosis such as all-cause and cardiovascular-related mortality [8, 13,14,15,16,17]. Mehrotra et al [8] discussed baseline and time-averaged serum albumin levels and changes in serum albumin levels, but they did not mention serum albumin levels at the onset of infectious disease
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