Abnormal Albumin Levels Research Articles

Kegiatan Pengabdian Masyarakat Dalam Rangka Penapisan Kadar Protein Dan Profil Lipid Terhadap Sarkopenia Pada Kelompok Lanjut Usia

The risk of sarcopenia and metabolic complications in the elderly can be caused by the aging process and decreased muscle mass in the elderly group. Sarcopenia and obesity in the elderly also increase the risk of cardiovascular disease, diabetes, and physical disability, which have the potential to reduce quality of life and increase morbidity and mortality. The purpose of this community service activity is to screen protein levels and lipid profiles in the elderly group in order to detect the risk of sarcopenia and dyslipidemia early. This activity is carried out using the Plan-Do-Check-Action (PDCA) method which includes planning, implementation, supervision, and follow-up. The community service activity was carried out at Panti Bina Bhakti, South Tangerang, involving 93 elderly participants aged >65 years. The results of the activity showed that 35 people (37.63%), 9 people (9.68%), 35 people (37.63%), and 7 people (7.53%) each had abnormal lipid profiles for HDL, Cholesterol, LDL, and Triglycerides. While 24 people (25.81%) had abnormal albumin levels. Therefore, it is necessary to monitor protein levels and lipid profiles regularly as well as early intervention through a healthy diet, regular exercise, and education for the elderly to maintain muscle mass and muscle strength.

A novel near-infrared-II fluorescence probe for serum albumin biosensing and site-binding mechanism study

Abnormal albumin levels are predictors of nephropathy, liver cirrhosis, coronary heart disease, and diabetes. Sensitive and rapid detection of endogenous albumin is of great significance to disease diagnosis and new drug discovery. Here, the first near-infrared-II fluorescence probe for albumin was developed. Based on the remarkable fluorescence enhancement induced by albumin, both human serum albumin (HSA) and bovine serum albumin (BSA) were quantified in several minutes. The limit of detection for albumin in urine samples is as low as 50 nM, which meets the requirement well for clinical analysis. The fluorescence imaging of drug-induced albumin in living cells verified strong capability for the probe to monitor the endogenous albumin. The site-binding mechanism between the probe and albumin was investigated via Job's plots analysis, drug substitution assays, and molecular docking. The NIR-II probe exhibits a specific and high-affinity binding (Kb=5.26×1011 M−1) with albumin, which enabled a further determination of trypsin and a protease inhibitor. This novel versatile biosensor provides a promising strategy for on-site evaluating of endogenous albumin for clinical diagnostics and drug screening.

Prognostic value of anthropometric- and biochemistry-based nutrition status indices on blood chemistry panel levels during cancer treatment

Body weight, body mass index (BMI), Nutrition Risk Screening 2002 (NRS2002), and prognostic nutritional index (PNI) are among vital nutrition status indices employed during cancer treatment. These have also been associated with levels of blood chemistry panels (BCPs), which are touted as significant indicators of disease prognosis. However, it remains unclear which nutrition status index better predicts future trends in specific BCPs. Using the records of 407 cancer patients, we retrospectively examined the potential of nutritional status indices at baseline for predicting changes in specific BCPs over a 6-week period. Generally, both serum biochemical parameters and nutrition status indices fluctuated over the study period among study participants. PNI was often linearly associated with blood cell counts (white blood cells [WBCs] and hemoglobin) compared with anthropometric-based nutrition status indices. Increase in body weight was protective against having abnormal lymphocyte levels at 6 weeks (odds ratio [OR]: 0.960–0.974; CI: 0.935–0.997; P < 0.05), while increase in baseline PNI was associated with 0.865–0.941 and 0.675–0.915 odds of having future abnormal WBC and lymphocyte levels, respectively. Increases in PNI were also protective against having future abnormal albumin levels (OR: 0.734–0.886) and 8.5–12.5% decreases in the odds of having an abnormal C-reactive protein level in subsequent visits. Changes in NRS2002 tended to be associated with the odds of having future abnormal blood glucose levels. In conclusion, the serum biochemistry–derived nutrition status index, PNI, is a more consistent measure as an early indicator to track the trends of future changes in the BCPs of cancer patients. This implies that PNI could be targeted as an early-warning measure with relevant preventive interventions for patients at risk of malnutrition.

Pressure injuries in COVID-19 patients: A tertiary center experience

Pressure ulcers continue to severely impact patient outcomes and increase health care costs. We aimed to examine the incidence and risk factors related to pressure ulcers among COVID-19 patients. A retrospective was conducted between March 2020-April 2021. Baseline differences were examined using chi-square and Fischer's exact test. Logistic regression was employed to examine the association of the collected variables to development of new pressure ulcers. 4608 patients were included, of which eighty-three acquired new pressure ulcers. Risk factors were increased age, peripheral artery disease, abnormal albumin levels, but not prone position.

Preoperative frailty to predict short-term outcomes in patients with cancer.

810 Background: Frailty is associated with increased postoperative complications. Despite multiple evidence-based modalities to assess frailty, surgeons often make subjective assessments of patients’ ability to tolerate surgery. Identification of those at risk of poor outcomes is particularly important in Surgical Oncology, as major resections may worsen debility and functional status, limiting the patients' ability to receive further therapy. The Risk Analysis Index (RAI-C) is a validated tool to assess frailty in surgical patients. It assigns points for any cancer diagnosis, potentially overestimating frailty in Surgical Oncology patients, and has not been validated in this subgroup. Methods: We performed a prospective, surgeon-blinded study to correlate results of a preoperatively administered frailty survey to predict short- and long-term outcomes in patients with histologically proven malignancy who underwent surgery. The RAI-C, Patient Health Questionnaire (PHQ9), and General Anxiety Disorder (GAD) surveys were administered to assess for frailty, depression, and anxiety, respectively; C-reactive protein (CRP), pre-albumin, albumin, and hematocrit were obtained. Outcomes, including readmission, major complications, ICU admission, disposition (home vs rehabilitation/nursing facility), and 1-year survival were compared between the different groups as defined by survey and lab results. Results: One hundred ninety-one patients were included, of which 135 patients were considered frail based on the predefined value (RAI-C ≥21). Frail patients were more likely to be readmitted within 30 days (14% vs 2%, P=0.01). No difference was found in length of stay, 90-day readmission, ICU admission, major complications, or disposition. Only 15.8% of patients met criteria for anxiety and 11% met criteria for depression. Measured outcomes were similar in patients defined as anxious or depressed. Patients with abnormal pre-albumin levels were more likely to require ICU admissions (31% vs 8%, P &lt;0.005), postoperative intubation (12% vs 0.02%, P=0.02), and to be discharged to a facility other than home (19% vs 10%, P=0.01). Similar trends were noted for patients with abnormal albumin levels who also had longer lengths of stay (mean 9.32 vs 7.88 days, P=0.007). There was an association of improved 1-year survival in patients with normal CRP, pre-albumin, albumin, and hematocrit levels. Frailty as determined by RAI-C survey was not associated with decreased 1-year survival. Conclusions: The RAI-C is a validated tool that can be used for prescreening of Surgical Oncology patients at risk of postoperative readmission, however the score did not correlate with other important outcomes including major morbidity, discharge disposition, and 1-year survival. Results from the survey, as well as preoperative laboratory results can be used in screening patients who may benefit from preoperative optimization and increased follow-up.

Liver function tests in COVID 19: A retrospective record-based study from a tertiary care centre in urban Maharashtra, India

BackgroundCOVID-19 is a multi system disorder and causes various abnormalities in liver function tests. The aim of this study was to estimate the prevalence of abnormal liver function tests in patients of COVID-19 and to describe the association of liver function tests with clinical features and disease severity in these patients. MethodsWe retrospectively evaluated and analyzed the liver function tests of all real-time polymerase chain reaction (RT-PCR) positive COVID-19 patients admitted to a tertiary care hospital in Western Maharashtra. The Institutional Ethics Committee of our hospital approved the study. ResultsOf the 533 patients included in our study, 50% had abnormal albumin levels while 40.1%, 43.5%, 9.3%, and 6.3% patients had deranged alanine transaminase (ALT) aspartate transaminase (AST), total protein and bilirubin levels, respectively. Hepatocellular injury was observed in 21 (3.9%) patients, and cholestatic liver injury was observed in seven (1.3%) patients. Abnormal liver function test (LFT) was significantly associated with disease severity but not with mortality. ConclusionAbnormal LFT in patients of COVID-19 is associated with severe disease but not mortality. Liver injury is common in patients of COVID-19.

Influence of overweight and obesity on the mortality of hospitalized patients with community-acquired pneumonia.

BACKGROUNDObesity is associated with a better prognosis in patients with community-acquired pneumonia (the so-called obesity survival paradox), but conflicting results have been found. AIMTo investigate the relationship between all-cause mortality and body mass index in patients with community-acquired pneumonia.METHODSThis retrospective study included patients with community-acquired pneumonia hospitalized in the First Hospital of Qinhuangdao from June 2013 to November 2018. The patients were grouped as underweight (< 18.5 kg/m2), normal weight (18.5-23.9 kg/m2), and overweight/obesity (≥ 24 kg/m2). The primary outcome was all-cause hospital mortality.RESULTSAmong 2327 patients, 297 (12.8%) were underweight, 1013 (43.5%) normal weight, and 1017 (43.7%) overweight/obesity. The all-cause hospital mortality was 4.6% (106/2327). Mortality was lowest in the overweight/obesity group and highest in the underweight group (2.8%, vs 5.0%, vs 9.1%, P < 0.001). All-cause mortality of overweight/obesity patients was lower than normal-weight patients [odds ratio (OR) = 0.535, 95% confidence interval (CI) = 0.334-0.855, P = 0.009], while the all-cause mortality of underweight patients was higher than that of normal-weight patients (OR = 1.886, 95%CI: 1.161-3.066, P = 0.010). Multivariable analysis showed that abnormal neutrophil counts (OR = 2.38, 95%CI: 1.55-3.65, P < 0.001), abnormal albumin levels (OR = 0.20, 95%CI: 0.06-0.72, P = 0.014), high-risk Confusion-Urea-Respiration-Blood pressure-65 score (OR = 2.89, 95%CI: 1.48-5.64, P = 0.002), and intensive care unit admission (OR = 3.11, 95%CI: 1.77-5.49, P < 0.001) were independently associated with mortality.CONCLUSIONAll-cause mortality of normal-weight patients was higher than overweight/ obesity patients, lower than that of underweight patients. Neutrophil counts, albumin levels, Confusion-Urea-Respiration-Blood pressure-65 score, and intensive care unit admission were independently associated with mortality in patients with community-acquired pneumonia.

Risk Factor Related to Mortality of Diabetic Ketoacidosis Patients in Dr. Soetomo General Hospital Surabaya

Introduction: Diabetic ketoacidosis (DKA) is a complication of diabetes mellitus which has a high risk of mortality. Mortality in DKA patients in developed countries is less than 5%, some other sources mention 5-10%, 2-10%, or 9-10%. Mortality events at clinics with simple facilities and elderly patients can reach 25-50%. The mortality rate of DKA patients is generally higher in infection conditions, especially in developing countries and in septic patients. Several factors such as age, sex, and high blood glucose can increase mortality risk of DKA patients. Other risk factors such as history of discontinued insulin therapy, impaired bicarbonate levels, pH, and increased leukocytes of DKA patients due to infection, abnormal albumin levels, electrolyte disturbances, and Serum Creatinine (SK) were thought to affect mortality of DKA patients. The purpose of this study was to determine the risk factors associated with mortality of DKA patients in Dr. Soetomo General Hospital Surabaya. Methods: The method used in this study was observational analytic involving 63 adult patients diagnosed with DKA with analysis using Chi-Square test. Results: From 63 patients included in this study, 37 patients diagnosed with DKA died and 26 patients lived. In a multivariate analysis, DKA severity with p = 0.001 (p &lt; 0.005) was identified as having a relationship with mortality of DKA patients Dr. Soetomo General Hospital Surabaya. Conclusion: Severity is the only risk factor associated with mortality of DKA patients in Dr. Soetomo General Hospital Surabaya.

Serum anion gap at admission as a predictor of mortality in the pediatric intensive care unit

An accurate method to predict the mortality in the intensive care unit (ICU) patients has been required, especially in children. The aim of this study is to evaluate the value of serum anion gap (AG) for predicting mortality in pediatric ICU (PICU). We reviewed a data of 461 pediatric patients were collected on PICU admission. Corrected anion gap (cAG), the AG compensated for abnormal albumin levels, was significantly lower in survivors compared with nonsurvivors (p < 0.001). Multivariable logistic regression analysis identified the following variables as independent predictors of mortality; cAG (OR 1.110, 95% CI 1.06–1.17; p < 0.001), PIM3 [OR 7.583, 95% CI 1.81–31.78; p = 0.006], and PRISM III [OR 1.076, 95% CI 1.02–1.14; p = 0.008]. Comparing AUCs for mortality prediction, there were no statistically significant differences between cAG and other mortality prediction models; cAG 0.728, PIM2 0.779, PIM3 0.822, and PRISM III 0.808. The corporation of cAG to pre-existing mortality prediction models was significantly more accurate at predicting mortality than using any of these models alone. We concluded that cAG at ICU admission may be used to predict mortality in children, regardless of underlying etiology. And the incorporation of cAG to pre-existing mortality prediction models might improve predictability.

Mo1209 Assessing Performance and Perceived Fatigue in Adolescents With Crohn's Disease: Is There an Association With Disease Activity?

normal albumin levels (75%), platelet counts (53%), and CRP levels (64%) at wk 52 (Table). HD ADA also improved mean hemoglobin levels at wk 52 (mean change from BL LD -0.96 v. HD 3.43 g/L, p<0.001). CONCLUSION. ADA led to normalization of laboratory values in clinically meaningful proportions of pts who had abnormal albumin levels, platelet counts, and CRP levels at BL in IMAgINE 1. Improvements in hemoglobin levels were also observed at wk 52. Reference: 1. Hyams et al Gastroenterol 2012;143:365 Normalization of laboratory values in pts with abnormal values at BL (LOCF)

Author reply to: serum ischaemic-modified albumin levels might not be a marker of oxidative stress in patients with hypothyroidism

To the Editor, We have read the critics of Reddy et al. [1] with a great interest. We are grateful for the inspiring comments on our manuscript reported in the April 2013 issue of the Endocrine [2]. The patients in our study were divided into three groups: hypothyroid, subclinical hypothyroid and control. No significant difference was determined among these three groups in terms of the parameters hyperlipidemia and metabolic syndrome. Hypothyroidism can give rise to hypercholesterolemia, and this has been shown to be reversible with thyroid hormone replacement [3]. The data concerning the relation between subclinical hypothyroidism and hyperlipidemia are inconsistent. There are studies reporting no significant difference in plasma lipid levels in patients with subclinical hypothyroidism compared to controls [4, 5]. While in our study low-density lipoprotein (LDL) cholesterol levels were slightly higher in patients with evident hypothyroidism compared to those with subclinical hypothyroidism and the control group, no statistically significant difference was determined. We already have highlighted that as our groups did not differ for lipid levels on contrary to Ma and colleaugues’ study [6] we think that the possible effect that may arise from different lipid levels have been excluded in our study. The relatively low patient numbers in our study may have been involved in this. While a relation is reported between total cholesterol levels and ischaemic-modified albumin (IMA), this was not evaluated in our study since it is not a component of metabolic syndrome. While metabolic syndrome was slightly higher in evidently hypothyroid patients in our study, no statistically significant difference was determined among the three groups in terms of metabolic syndrome. There was no significant difference between the metabolic patient and control groups in terms of IMA levels. The authors pointed the study by Gottlieb and colleagues in which IMA levels were found to be higher than control group among patients with metabolic syndrome; however, in that study also similar to Ma and colleagues’ study [6] body mass index (BMI), waist circumference, blood pressure (systolic and diastolic), glucose levels and lipid levels (total cholesterol, LDL and HDL) were higher among patients with metabolic syndrome [7]. Although they have performed multivariate analysis for BMI and lipids they do not ignore the potential effect of these parameters on IMA levels in the discussion section [7]. It has been reported that hypothyroidism and subclinical hypothyroidism may be associated with an atherosclerotic process and chronic ischaemia [8]. In addition, a rise in metabolic rate as a result of the biological effect of thyroid hormones and a rise in oxygen radicals with calorigenesis has been reported [9]. It has also been reported that metabolic processes decelerating in hypothyroidism and decreasing oxygen radical production may have a protective effect against ischaemia [10]. The authors emphasised that the level of albumin is correlated with IMA levels and the absence of albumin levels of our patients. They are completely right, but our study group had no other diseases, other than thyroid disease; patients with abnormal albumin levels were not included in the study. Testing the binding of albumin to cobalt is a technique that measures IMA levels indirectly, and low albumin levels have been reported to be capable of affecting IMA levels. Gaze et al. reported a negative correlation between serum albumin levels and IMA levels, but I. Anaforoglu (&) K. Ersoy E. Algun Department of Endocrinology and Metabolism, Trabzon Kanuni Education and Research Hospital, 61000 Trabzon, Turkey e-mail: ianaforoglu@hotmail.com

Risk Factors of Delirium after Cardiac Surgery: A Systematic Review

Delirium or acute confusion is a temporary mental disorder that occurs frequently among hospitalized elderly patients, but also in younger patients a delirium can develop. Patients who undergo cardiac surgery have an increased risk of developing delirium that is associated with many negative consequences. Therefore, prevention of delirium is essential. Despite the high incidence of delirium, a paucity of data on risk factors for delirium exists. The aim of this study was to summarize the available information concerning these risk factors. A literature research was performed using the PubMed, Cinahl, and Cochrane Library databases and was limited to the last 10 years. Our review revealed 27 risk factors; 12 predisposing and 15 precipitating factors for delirium after cardiac surgery. The most established predisposing risk factors were atrial fibrillation, cognitive impairment, depression, history of stroke, older age, and peripheral vascular disease. The most established precipitating risk factor was a red blood cell transfusion. An abnormal albumin level was reported as the most established precipitating risk factor among blood values tested. A low cardiac output and the use of an Intra Aortic Balloon Pump or inotropic medication seem to be the most relevant risk factors associated with a postoperative delirium. A multifactorial risk model should be applied to identify patients at an increased risk of developing delirium following elective cardiac surgery. In these patients, if possible, preventative interventions can be taken and early recognition of delirium can be realized. This could potentially decrease the incidence of delirium and negative consequences caused by a postoperative delirium.

The Use of Biochemical Parameters as Nutritional Screening Tools in Surgical Patients

Nutritional status influences surgical outcome and complication rates. The National Institute of Clinical Excellence (NICE) recommends screening patients on admission; yet traditional nutritional screening tools are underutilised. This retrospective case-control study investigates the association between biochemical factors and adverse outcomes in orthopaedic patients to ascertain whether they could provide more suitable alternatives to traditional screening tools. 66 patients with fractured neck of femur were investigated. Adverse outcomes including Length of Stay (LOS), and deaths were recorded. Total Lymphocyte Counts (TLC), Serum Albumin Levels and Haemoglobin levels, were recorded pre-operatively (pre-op) and post-operatively (post-op). Adverse outcomes in those with normal and abnormal biochemical values were compared using Chi Squared and T Testing. Linear associations were tested for using Pearson rank correlation. Automated Nutrition Scores Beta (ANSB) were calculated and their relationship to adverse outcomes investigated. Protein energy malnutrition was common on admission. However, only 2 patients were nutritionally screened during admission. Those patients with abnormal pre-op TLC had an increased LOS in hospital. Those with abnormal albumin and/or TLC had increased mortality rates. Abnormal albumin levels were associated with a significant 3 fold increase in mortality (p = 0.009) and post-operative TLC were found to be negatively correlated with LOS (r = –0.3, p = 0.038). ANSB were also found to correlate with increased adverse outcomes although this was not significant. This study demonstrates that nutritional status is poorly assessed on admission in orthopaedic patients and consequently that provision of nutritional supplements is suboptimal. This study also demonstrates a highly significant relationship between abnormal albumin and adverse outcomes and identifies a new correlation between post-operative TLC and LOS. This study confirms that individual biochemical parameters and biochemical scores can be used to identify orthopaedic patients at particular risk of adverse post-op outcomes. These biochemical screening methods may be a more efficient and reliable way of stratifying malnutrition associated risk on admission.

Administration of Olanzapine to Prevent Postoperative Delirium in Elderly Joint-Replacement Patients: A Randomized, Controlled Trial

Delirium is a serious postoperative condition for which few pharmacologic prevention trials have been conducted. The authors tested the efficacy of perioperative olanzapine administration to prevent postoperative delirium in elderly patients after jointreplacement surgery. The authors conducted a randomized, double-blind, placebocontrolled, prophylaxis trial at an orthopedic teaching hospital, enrolling 495 elderly patients age ≥65 years, who were undergoing elective knee- or hip-replacement surgery; 400 patients received either 5 mg of orally-disintegrating olanzapine or placebo just before and after surgery. The primary efficacy outcome was the incidence of (DSM-III-R) delirium. The incidence of delirium was significantly lower in the olanzapine group than in the placebo group; this held true for both knee- and hip-replacement surgery. However, delirium lasted longer and was more severe in the olanzapine group. Advanced age, a high level of medical comorbidity, an abnormal albumin level, and having knee-replacement surgery were independent risk factors for postoperative delirium (Clinicaltrials.gov Identifier: NCT000699946). Administration of 10 mg of oral olanzapine perioperatively, versus placebo, was associated with a significantly lower incidence of delirium. These findings suggest that olanzapine prophylaxis of postoperative delirium may be an effective strategy.

Administration of Olanzapine to Prevent Postoperative Delirium in Elderly Joint-Replacement Patients: A Randomized, Controlled Trial

Delirium is a serious postoperative condition for which few pharmacologic prevention trials have been conducted. The authors tested the efficacy of perioperative olanzapine administration to prevent postoperative delirium in elderly patients after joint-replacement surgery. The authors conducted a randomized, double-blind, placebo-controlled, prophylaxis trial at an orthopedic teaching hospital, enrolling 495 elderly patients age ≥65 years, who were undergoing elective knee- or hip-replacement surgery; 400 patients received either 5 mg of orally-disintegrating olanzapine or placebo just before and after surgery. The primary efficacy outcome was the incidence of (DSM-III-R) delirium. The incidence of delirium was significantly lower in the olanzapine group than in the placebo group; this held true for both knee- and hip-replacement surgery. However, delirium lasted longer and was more severe in the olanzapine group. Advanced age, a high level of medical comorbidity, an abnormal albumin level, and having knee-replacement surgery were independent risk factors for postoperative delirium (Clinicaltrials.gov Identifier: NCT000699946). Administration of 10 mg of oral olanzapine perioperatively, versus placebo, was associated with a significantly lower incidence of delirium. These findings suggest that olanzapine prophylaxis of postoperative delirium may be an effective strategy.

Ischemia-modified albumin and cardiovascular risk markers in polycystic ovary syndrome with or without insulin resistance

The aim of this study was to evaluate ischemia-modified albumin levels (IMA) in polycystic ovary syndrome (PCOS) cases with and without insulin resistance and the correlation of IMA with carotid intima media thickness, homocysteine, and high-sensitivity C-reactive protein levels. Significantly higher levels of IMA in young lean PCOS cases, more relevant in insulin resistant cases, indicates chronic hypoxia and oxidative stress which might play a role in the metabolic consequences in PCOS.