Serum Hypoalbuminemia Is a Long-Term Prognostic Marker in Medical Hospitalized Patients, Irrespective of the Underlying Disease.

Howard S Oster,Yardenna Dolev,Moshe Mittelman,Ahuva Weis-Meilik,Orli Kehat

doi:10.3390/jcm11051207

Howard S Oster, Yardenna Dolev + Show 3 more

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https://doi.org/10.3390/jcm11051207

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Abstract

Hypoalbuminemia is common in hypoalbuminemia-associated disorders (HAD), e.g., liver and kidney disease. We hypothesize that hospitalized patients with hypoalbuminemia have poor prognosis irrespective of their underlying disease. Records of patients admitted to Medicine (2010–2018), with and without HAD were analyzed, comparing low (<35 g/L) to normal serum albumin. Mann–Whitney and Chi-squared tests were used, and a logistic regression model was applied. Patients: 14,640 were admitted; 9759 were analyzed (2278 hypoalbuminemia: 736 HAD, 1542 non-HAD). All patients, and the subgroups with (as expected) and without HAD had worse outcomes. Specifically, in patients without HAD, those with hypoalbuminemia (n = 1542) vs. normal albumin (n = 6216) were older, had a higher Charlson Comorbidity Index (CCI, 5 vs. 4), longer median hospital stay (5 vs. 4), higher one year re-admission rate (49.9% vs. 39.8%), and one year mortality (48.9% vs. 15.3%, p < 0.001 for all). LR model predicting 3 month, 1 year and 5 year mortality confirmed the predictive power of albumin (1 year: OR = 4.49 for hypoalbuminema, p < 0.01). Hypoalbuminemia portends poor long-term prognosis in hospitalized patients regardless of the underlying disease and could be added to prognostic predictive models.

Highlights

Albumin is a water-soluble 65kD protein [1], synthesized by the liver [2]
In the HAD analysis, we focused on patients with hypoalbuminemia-associated disorders and made a similar comparison between patients with hypoalbuminemia and those with normal serum albumin
This study was based on clinical observations in the inpatient internal medicine wards and some previous studies, leading us to hypothesize that patients with hypoalbuminemia do worse than those with normal serum albumin, regardless of the underlying diseases or comorbidities

Summary

Introduction

Albumin is a water-soluble 65kD protein [1], synthesized by the liver [2]. It is the most abundant blood protein in humans, constituting about half of serum proteins, responsible for the oncotic pressure of the blood. The serum half-life of the molecule is approximately 20 days. Some of albumin’s main functions are binding non-soluble molecules in the serum and transporting medications and hormones [3]. The level of albumin considered as normal varies depending on the study. Most consider hypoalbuminemia as serum albumin levels lower than 34 or 35 g/L [4–6]. Several processes control plasma albumin concentration, including the absolute rate of albumin synthesis, the catabolic rate of the body, albumin distribution between the vascular and extravascular compartments and exogenous loss of albumin. The rate of albumin synthesis is affected by both nutrition and inflammation [7]

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