Changes In Serum Albumin Levels Research Articles

Improvement of Hypoalbuminemia and Hepatic Reserve after Stent Placement for Post-Surgical Portal Vein Stenosis.

To investigate the change in serum albumin levels and hepatic reserve scores before and after portal vein stent placement (PVS) for post-surgical portal vein stenosis. A retrospective cohort of patients undergoing PVS after abdominal surgery between 2007 and 2021 was analyzed. Patients' age, sex, and PVS technical success (defined by portal vein patency at final portography) were evaluated. Serum albumin (Alb), prothrombin international ratio (PT-INR), total bilirubin (Tbili), platelet counts (Plt), Child-Pugh scores (CPS), and albumin-bilirubin (ALBI) scores/grades before and one month after PVS were compared. Normally distributed variables were summarized as mean ± standard deviation and compared with paired t-tests. Skewed variables were summarized as median [interquartile range] and compared with signed-rank tests. Twenty-five patients (age 61±10 years; 44% female) were included. Technical success of PVS was achieved in all. Comparison was conducted for 28 PVS sessions: Alb elevated from 3.1±0.6 to 3.5±0.5 g/dL (P=0.006), with greatest change in patients with pre-PVS Alb ≤2.9 g/dL (2.6±0.3 to 3.3±0.4 g/dL, P<0.001). Improvements in CPS (P=0.026), ALBI score (P=0.002), and ALBI grades (P=0.026) were observed. PT-INR elongated (1.2 [1.1-1.3] to 1.3 [1.2-1.6]; P=0.002), mainly because of patients receiving post-PVS warfarin (P=0.005 and P=0.20 for with and without warfarin). No significant changes were observed for Tbili (P=0.40) and Plt (P=0.25). Improvement of liver synthetic function represented by serum albumin levels and in hepatic reserve scores were observed after PVS, particularly in patients with pre-PVS hypoalbuminemia.

Development of a novel NIR-II fluorescence probe for monitoring serum albumin fluctuation in cerebra neurotoxicity induced by manganese exposure.

Manganese is essential for various biological functions; however, excessive exposure can lead to significant health risks, particularly brain neurotoxicity. Understanding manganese-induced alterations in brain serum protein levels and brain function is crucial for elucidating the mechanisms underlying manganese neurotoxicity. To address this, we developed a novel NIR-II fluorescent probe, RSM, characterized by robust binding to serum albumin and high sensitivity. Using RSM, we observed that heightened BSA uptake in cells exposed to elevated manganese concentrations relative to those exposed to lower levels. Furthermore, we successfully detected changes in serum albumin levels induced by manganese neurotoxicity in brain tissue through in situ NIR-II fluorescence imaging. Our findings establish an association between augmented manganese-induced neurotoxicity and elevated serum albumin content in the brain. This work provides a valuable tool for further investigating the mechanisms of toxic molecules.

Nutritional outcomes between different techniques of intradialytic amino acid replacement: a randomized controlled trial

Abstract Background Amino acid (AA) depletion during dialysis deteriorates protein-energy status of hemodialysis (HD) patients. This study aimed to determine whether intradialytic amino acid (IDAA) replacement by continuous infusion versus acute load could provide better nutritional outcomes. Methods HD patients with mild protein-energy wasting, defined as serum albumin level of 3.5–3.9 mg/dL despite 7-point SGA in category A or malnutrition inflammation score ≤ 5, were randomly assigned to receive IDAA by continuous infusion or acute load for 3 months. In continuous infusion (n = 24), 50% glucose followed by 7.2% branched-chain enriched AA solution were instilled at first 15 mins after HD initiation with high-flux dialyzer through the end of session. Similar parenteral nutrition compositions containing the same total amount of glucose and AA were rapidly added into venous drip chamber within the last hour of HD in the acute load group (n = 24). Primary outcome was the change in serum albumin level. Secondary outcomes were changes in muscle parameters, and plasma as well as dialysate AA concentrations. Results Mean age of patients was 68.9 ± 12.7 years and average body mass index of 22.8 ± 4.4 kg/m2 with 45.8% men. After 3 months, serum albumin levels were significantly elevated in continuous infusion (P = 0.001) whereas it was unchanged in acute load (P = 0.13). Despite comparable energy and protein intake, total-body muscle mass was also increased in continuous infusion group at 3 months (P = 0.03) compared with no significant change in acute load group (P = 0.45). Amount of AA loss into dialysate was similar between two groups (P = 0.17). At post-dialysis, most plasma essential and non-essential AA levels were significantly lower in patients receiving continuous infusion than acute load while branched-chain AA concentrations including leucine (P = 0.61) and valine (P = 0.09) were comparable between two groups. Despite enhancing muscle mass in continuous infusion, handgrip strength and gait speed were unaltered in both techniques of IDAA replacement. Conclusions IDAA using continuous infusion appears to be superior to acute load in terms of serum albumin and muscle mass improvement. The impact of IDAA on hard clinical outcomes may require larger scale with longer period of study (TCTR20230401003).

Diagnostic Value of Ischemia-Modified Albumin as a Biomarker in Patients with Peripheral Vertigo at Emergency Department of State Hospital in Ankara: A Cross-Sectional Study.

In previous studies, it was shown that ischemia-modified albumin (IMA) is an early marker of ischemia and different pathologies. However, IMA level change is unknown in patients with peripheral vertigo. It is also known that serum albumin levels can change in some patients with peripheral vertigo and that changes in serum albumin levels affect IMA levels. In this study, we aimed to assess IMA, albumin-adjusted IMA, and albumin levels in patients with peripheral vertigo by comparing a control group. This prospective, case-control study included 46 patients aged 18-70 years who presented to emergency department with vertigo. Forty-nine healthy volunteers without known disease were included as controls. Serum albumin and IMA levels were measured, and albumin-adjusted IMA levels were calculated. Data were analyzed by statistical methods. Mean age was 54.0 ± 15.7 in the patient group, whereas 43.8 ± 9.9 years in the control group. Albumin level was found to be significantly lower in patients with peripheral vertigo when compared to controls (P < 0.001). IMA level was found to be higher in the patient group compared to the controls, but it was not statistically significant (P = 0.06). However, albumin-adjusted IMA, which shows the real IMA level, was found to be higher than the control group (P = 0.02). It was observed that IMA level was slightly higher in patients with peripheral vertigo, although not significantly, compared to the control group. However, the albumin-adjusted IMA level, which indicates the real IMA level, was observed to be higher in this group than in the control group. It was determined that the sensitivity of this test was 34%, and the specificity was 87%. Patients with peripheral vertigo had lower albumin levels compared to controls.

Cumulative postoperative change in serum albumin levels and organ failure after living-donor liver transplantation: A retrospective cohort analysis.

Many studies have reported that hypoalbuminemia could be associated with organ failure after liver transplantation. However, most of them focused on serum albumin levels measured at specific time points and not on the trend of serum albumin change. We investigated whether a cumulative postoperative change in serum albumin level up to postoperative day (POD) 5 is related to organ failure in patients who underwent living-donor liver transplantation (LDLT). Data of adult recipients who underwent LDLT between January 2016 and December 2020 at a single tertiary hospital were reviewed (n = 399). After screening, three patients were excluded because of insufficient data. A cumulative change in serum albumin level was demonstrated using the area under the threshold (AUT, threshold = 3.0 g/dL) of the serum albumin curve up to POD 5. Based on the AUT, the patients were divided into a high-decrease group (n = 156) and a low-decrease group (n = 240). All analyses were conducted using 1:1 propensity score matching. The primary endpoint was the Sequential Organ Failure Assessment (SOFA) score on POD 5. The secondary endpoints were postoperative hospital stay and postoperative 90-day mortality. A total of 162 patients were included. The SOFA score on POD 5 was significantly higher in the High-decrease group compared with the Low-decrease group (5.2 ± 2.6 vs. 4.1 ± 2.3; mean difference: 1.1, 95% CI: 0.3 to 1.8; P = 0.005). However, the length of postoperative hospital stay (P = 0.661) and 90-day mortality (P = 0.497) did not differ between the groups. In conclusion, a cumulative postoperative change in serum albumin level up to POD 5 could help predict postoperative organ failure on POD 5 in patients who underwent LDLT.

Positive Correlation Between Changes in Serum Albumin Levels and Breakfast Non-Protein Calorie/Nitrogen Ratio in Geriatric Patients.

Differences in nutrition intake by meal intake time of geriatric patients may affect albumin (Alb) synthesis ability. We included 36 geriatric patients (81.7 ± 7.7 years; 20 males and 16 females) as subjects. We calculated their dietary patterns (DPs) by computing intake by breakfast, lunch, and dinner, as well as by nutrient, for a weight of 1 kg/day for 4 weeks after hospitalization. We confirmed the relationship between "DP with a positive correlation with breakfast protein" and the change rate of albumin (Alb-RC). Then, we performed linear regression analysis to explore factors influencing Alb-RC and compared non-protein calorie/nitrogen ratio (NPC/N) between the upper and lower Alb-RC groups. It was observed that Alb-RC was negatively correlated with "DP with a positive correlation with breakfast protein" (B = -0.055, P = 0.038) and positively correlated with breakfast NPC/N (B = 0.043, P = 0.029). Breakfast NPC/N tended to be higher in the upper group than in the lower group (P = 0.058). The study revealed that there was a positive correlation between Alb-RC levels and breakfast NPC/N in geriatric patients at the care mix institution.

Hypoalbuminemia Within One Hour After Surgery as a Predictor of Post-Operative Urosepsis in Patients Undergoing Flexible Ureteroscopy Lithotripsy: A Retrospective Study.

Abstract Background: To investigate retrospectively whether changes in serum albumin levels within one hour of flexible ureteroscopy (fURS) lithotripsy can be used as a predictor of post-operative urosepsis. Patients and Methods: Eligible patients with unilateral upper urinary calculi who underwent fRUS lithotripsy performed by a single surgeon at our center were included in the analysis. The patients were divided into sepsis and non-sepsis groups. The change ratio of albumin and white blood cell (WBC) count was calculated by post-operative/pre-operative index*100%. Univariable and multivariable logistic regression analyses were used to assess whether there was a correlation between risk factors and post-operative urosepsis. The receiver operating characteristic (ROC) curve was used to analyze factors that showed significant differences in multivariable logistic regression analysis. Results: A total of 314 patients were included in the analysis, 20 of whom had post-operative urosepsis and five developed septic shock; no deaths occurred. Multivariable logistic regression analysis showed that urine culture results, WBC counts within one hour after surgery, post-operative albumin levels, and the degree of albumin changes after surgery were independent predictors of post-operative urosepsis. Receiver operating characteristic curve analysis showed that noteworthy hypoalbuminemia after surgery and positive pre-operative urine culture could help screen high-risk patients for post-operative urosepsis effectively. Conclusions: Hypoalbuminemia shortly after operation can be utilized as a predictor for early diagnosis of post-operative urosepsis in patients undergoing fURS lithotripsy.

Worsening or improving hypoalbuminemia during continuous renal replacement therapy is predictive of patient outcome: a single-center retrospective study

BackgroundHypoalbuminemia at the initiation of continuous renal replacement therapy (CRRT) is a risk factor for poor patient outcomes. However, it is unknown whether the patterns of changes in serum albumin levels during CRRT can be used to predict patient outcomes.MethodsThis retrospective study analyzed data that had been consecutively collected from January 2016 to December 2020 at the Third Affiliated Hospital. We included patients with acute kidney injury who received CRRT for ≥ 72 h. We divided the patients into four groups based on their serum albumin levels (albumin ≥ 3.0 g/dL or < 3.0 g/dL) at the initiation and termination of CRRT.ResultsThe 793 patients in this study were categorized into the following albumin groups: persistently low, 299 patients (37.7%); increasing, 85 patients (10.4%); decreasing, 195 patients (24.6%); and persistently high, 214 patients (27.1%). In-hospital mortality rates were highest in the persistently low and decreasing groups, followed by the increasing and persistently high groups. The hazard ratio for in-hospital mortality was 0.481 (0.340–0.680) in the increasing group compared to the persistently low group; it was 1.911 (1.394–2.620) in the decreasing group compared to the persistently high group. The length of ICU stay was 3.55 days longer in the persistently low group than in the persistently high group.ConclusionsSerum albumin levels changed during CRRT, and monitoring of patterns of change in serum albumin levels is useful for predicting in-hospital mortality and the length of ICU stay.

Efficacy of intravenous combined immunosuppression with plasmapheresis in adult patients with refractory primary focal segmental glomerulosclerosis

Primary focal segmental glomerulosclerosis (FSGS) treatment is based on immunosuppressive therapies. Since refractory disease is common, alternative methods are emerging. One of these methods is plasmapheresis with intravenous cyclosporine and corticosteroids, and it could be an option in post-transplant recurrent FSGS. We retrospectively investigated the efficacy of this combined treatment in adult patients with refractory primary FSGS. Seven refractory primary FSGS patients were included. Demographics, estimated glomerular filtration rates, serum albumin levels, urine protein/creatinine ratios, and previous treatments were evaluated. Also, complications and remission rates were assessed. Median patient age was 23 years. Median duration of diagnosis was 2 years. Median number of plasmapheresis sessions was 14. Five of seven patients (71.4%, one complete, four partial remissions) were responders after the protocol. Changes in serum albumin levels and proteinuria after protocol were statistically significant (P= 0.018 and P= 0.018, respectively). eGFR levels did not change statistically (P= 0.753). Median follow-up duration after the treatment was 17 months. However, two patients experienced disease relapse (28.5%). End-stage kidney disease was developed in two patients. Sustained remission rate was 42.8% during follow-up (One complete and two partial remissions). Also, 42.8% of patients experienced catheter infections. Catheter-associated thrombosis that required surgery was observed in a patient. Plasmapheresis combined with intravenous cyclosporine and corticosteroids could be an option in refractory primary FSGS. High response rates after this protocol were encouraging. However, the relapsing disease was observed after the cessation of apheresis. Also, complications of the protocol could limit the applicability.

Comparative efficacy between hemodialysis using super high-flux dialyzer with hemoperfusion and high-volume postdilution online hemodiafiltration in removing protein bound and middle molecule uremic toxins: A cross-over randomized controlled trial.

Hemodialysis (HD) using super high-flux dialyzer (HD+SHF) comparably removed uremic toxins to high-volume postdilution online hemodiafiltration (olHDF). Integration of hemoperfusion (HP) to HD+SHF (HD+SHF+HP) might provide superior uremic toxin removing capability to high-volume postdilution olHDF. The present study was conducted in thrice-a-week HD patients to compare the efficacy in removing indoxyl sulfate (IS), beta-2 microglobulin (β2 M), and urea between high-volume postdilution ol-HDF and HD+SHF+HP, comprising HD+SHF as the main treatment plus HD+SHF+HP 1/week in the first 4weeks and 1/2weeks in the second 4weeks. Ten prevalent HD patients with blood flow rate (BFR) above 400ml/min were randomized into two sequences of 8-week treatment periods of HD+SHF+HP and later high-volume postdilution olHDF or vice versa. When compared with high-volume postdilution olHDF (convective volume of 26.02±1.8 L/session), HD+SHF+HP provided comparable values of percentage reduction ratio of IS (52.0±11.7 vs. 56.3±7.5%, p=0.14) and β2 M (83.7±4.9 vs. 84.0±4.3%, p=0.37) and slightly lower urea reduction ratio. Despite greater dialysate albumin loss (p=0.008), there was no significant change in serum albumin level in HD+SHF+HP group. HD+SHF+HP could not provide superior efficacy in removing uremic toxins to high-volume postdilution olHDF. The use of low BFR of 200ml/min during the first 2h of HD+SHF+HP session, according to the instruction of manufacturer, might impair the efficacy of the HD+SHF part in removing uremic toxins.

Ameliorative Effects of Aqueous Extract of Date Palm Fruits (phoenix dactylifera) on high fat diet- induced Liver Damage in Adult Wistar Rats

Elevated cholesterol level is a major cause of disease burden in developing Nations. This study seeks to evaluate the ameliorative and hepatoprotective potentials of aqueous extract of date palm (Phoenix dactylifera) on high fat diet-induced liver damage. Thirty (30) adult wistar rats weighing 110-180g were randomly divided into six group of five animals each, group A served as control while B was exposed to high fat diet only (using margarine brand); Groups C, D and E were given high fat diet with co-treated with the extract at low, medium and high doses respectively while group F was received the drug Atrovastin as a gold standard to enable comparative effects of date palm administration. At the end of the treatment period, the animals were anaesthetized using chloroform blood samples were collected via cardiac puncture to investigate the activities of liver enzymes, and liver tissue was harvested through a midline incision for histological analysis. There were evidence of vascular congestion and periportal infiltration in rats given margarineonly indicative of hepatocellular disruption. Animals that received moderate to high dose of the fruit extract show mild to total reversal of the damaged liver cells and activation of kupffer cells with concurrent changes in serum albumin level. Aqueous extract of phoenix dactylifera was seen to ameliorate the fat induced liver damage with notable changes in hepatocyte configuration as observed when treated with standard drug.&#x0D; Keywords: Phoenix dactylifera, Hyperlipedermia, Liver, Wistar rat

Effect of L-carnitine on health-related quality of life in patients with liver cirrhosis.

L-carnitine (4-N-trimethylammonium-3-hydroxybutyric acid) is the physiologically active form of carnitine and is a natural compound that has been shown to exhibit antioxidant activity. L-carnitine is used as a supplementary treatment in patients with cirrhosis with hepatic encephalopathy, hyperammonemia or muscle cramps. In the present study, the effect of L-carnitine supplementation on health-related quality of life in 30 patients with cirrhosis was prospectively examined. L-carnitine (1,800 mg/day) was administered orally for 6 months. To assess the effects of L-carnitine on chronic fatigue, patients filled out a self-report questionnaire regarding their physical and mental health. The levels of total and free carnitine, and acylcarnitine were found to be significantly higher 1, 3 and 6 months after therapy initiation compared with before treatment. Serum albumin levels were significantly increased 3 and 6 months after initiation of therapy. L-carnitine supplementation significantly increased the BAP/d-ROM ratio, a marker of antioxidant status in patients with cirrhosis. Changes in serum carnitine concentrations were positively correlated with changes in serum albumin levels (R2=0.369; P=0.012), but not with changes in serum ammonia levels (R2= 0.005; P=0.78). Total and mental health scores improved significantly, and physical scores improved marginally 3 and 6 months after initiation of L-carnitine. These findings may be attributed to the enhanced serum albumin levels and oxidative stress rather than the reduced serum ammonia levels. Based on these results, it is suggested that L-carnitine can potentially alleviate chronic fatigue, along with the increased BAP/d-ROM ratio, which were involved in increased oxidative stress in patients with cirrhosis. The specific mechanisms by which L-carnitine ameliorates chronic fatigue is not fully understood and requires further investigation.

Efficacy and Safety of PCSK9 Inhibitors in Hypercholesterolemia Associated With Refractory Nephrotic Syndrome

IntroductionTreatment of hypercholesterolemia in refractory nephrotic syndrome remains a therapeutic challenge. There is not enough evidence supporting the efficacy of statins, and these drugs can be associated with an increased incidence of adverse effects. Herein we summarize our clinical experience with 12 patients suffering from refractory nephrotic syndrome with associated vascular disease and uncontrolled hypercholesterolemia despite treatment with statins who were treated with proprotein convertase subtilisin kexin 9 (PCSK9) inhibitors.MethodsTwelve adult patients with primary nephrotic syndrome refractory to multiple lines of immunosuppressive treatment who suffered from clinical atheromatous vascular disease were treated with PCSK9 inhibitors according to the prescription guidelines for secondary prevention of cardiovascular events. Eight patients with refractory nephrotic syndrome without vascular disease treated with atorvastatin comprised the control group.ResultsFour weeks after treatment with PCSK9 inhibitors, a statistically significant decrease in total cholesterol and low-density lipoprotein cholesterol (LDL-C) levels was observed without significant changes in serum albumin levels or proteinuria. The mean LDL-C decrease was 36.8% ± 4.9% mmol/L at 4 weeks and remained unchanged throughout the follow-up period. In the control group, there were no significant changes in the levels of total cholesterol or LDL-C during the follow-up period. At the diagnosis of nephrotic syndrome, plasma PCSK9 levels were 334 ± 40 ng/mL and correlated significantly with serum LDL-C levels (r = 0.49, P = 0.023). Six months after starting treatment with PCSK9 inhibitors, plasma PCSK9 levels were significantly reduced to values of 190 ± 36 ng/mL (P = 0.001) with a mean relative reduction of 42.3% ± 12.6%. No local adverse effects were seen at the injection site and no significant changes were seen in the levels of transaminase, creatine phosphokinase, or aldolase.ConclusionPCSK9 inhibitors may be an effective and safe alternative for the treatment of hypercholesterolemia associated with refractory nephrotic syndrome.

Perioperative improvement in serum albumin level in patients with left ventricular assist device.

The negative impact of baseline hypoalbuminemia on clinical outcome following left ventricular assist device (LVAD) implantation is well known. However, the implications of perioperative change in serum albumin levels on post-LVAD outcomes remain uninvestigated. Among consecutive patients with baseline serum albumin <3.5 g/dl who received durable LVAD implantation between April 2014 and August 2017 and were followed for 1 year, the impact of perioperative change in serum albumin level from baseline to 3 months post-LVAD on the incidence of adverse events was investigated. Sixty-eight patients (median 60 years and 69% male) were included. Serum albumin change was an independent predictor of the occurrence of adverse events with an adjusted hazard ratio of 0.32 (95% confidence interval, 0.13-0.78) and a cutoff change of 0.7 g/dl. Those with albumin increase >0.7 g/dl had higher 1-year freedom from adverse events (45% vs. 14%, p = .008), dominantly due to lower incidence of death or sepsis compared with those without (p < .05 for both). Among those with baseline hypoalbuminemia, a considerable perioperative increase in serum albumin levels following LVAD implantation was associated with lower mortality and morbidity. The implication of aggressive nutrition intervention on LVAD patients is the next concern.

The clinical impacts of early using glutamine/arginine enriched high protein density formula at trophic dose in intolerant enteral nutrition cachectic hypoalbuminemic hospitalized patients.

We sought to evaluate the clinical impacts of the early administration of trophic doses of a glutamine/arginine enriched enteral nutrition formula (ENF) with a high protein density to cachectic hypoalbuminemic hospitalized patients intolerant to enteral nutrition. A retrospective analysis was conducted using the nutritional and non-nutritional data of patients admitted to our institution from April 2017 through August 2019. Patients who died or were discharged before completing ≥1 weeks of hospital admission, or those whose data could not be obtained were excluded. Among other variables, percent changes in serum albumin levels (%∆ALB), C - reactive protein (CRP) and their ratios were expressed as Mean ± SD using the Independent Samples T-test, while categorical variables were expressed as numbers with percentages by using χ2 test. Two tested groups were determined based on the use of ENF: Group I received trophic doses of ENF, while Group II received no enteral nutrition. The overall hospital length of stay (LOS) and overall 28-day hospital mortality were significantly lower in Group I when compared with Group II with Means ± SDs of (11.32 ± 2.19 days vs 23.49 ± 4.33 days) and (13.13% vs. 28.16%), respectively. Also, significantly higher (%∆ALB) for Group I compared with group II (43.48% ± 7.89% vs. 33.45% ± 6.18%), respectively was observed. In malnourished hypoalbuminemic patients suffering from feeding intolerance, early trophic administration of glutamine/arginine enriched high protein density ENF was well tolerated and may be associated with increased plasma albumin levels, reduced LOS, and overall 28-day mortality, and hence may be considered in such patients.

Cerebral oxygenation improvement is associated with hemoglobin increase after hemodialysis initiation.

Near-infrared spectroscopy has been used to measure the regional oxygen saturation (rSO2) of the brain, and decreases in cerebral rSO2 have been reported to lead to cognitive impairment in patients undergoing hemodialysis. However, reports about the association between changes in cerebral oxygenation and clinical parameters at hemodialysis initiation, including hemoglobin level, are lacking. This study included 33 patients at the hemodialysis initiation phase. Cerebral rSO2 was monitored using an INVOS 5100C. Included patients were assessed twice (at hemodialysis initiation and 42.7 ± 20.8 days after the first measurement), and changes in cerebral rSO2 were compared with changes in clinical parameters. Cerebral rSO2 at the second measurement significantly increased compared with that at hemodialysis initiation (57.2 ± 6.8% vs 54.4 ± 8.8%, p < 0.05). Changes in cerebral rSO2 represented a significant correlation with changes in hemoglobin level, pulse rate, and serum albumin level. Multivariate linear regression analysis was performed using significant factors in simple linear regression analysis. Changes in hemoglobin (standardized coefficient: 0.37) and serum albumin (standardized coefficient: 0.45) levels were identified as independent factors influencing the changes in cerebral rSO2. Cerebral rSO2 was low in the presence of low hemoglobin levels at hemodialysis initiation and improved in response to hemoglobin increase in addition to changes in serum albumin levels. Attention should be paid to changes in hemoglobin levels even at hemodialysis initiation to prevent the deterioration of cerebral oxygenation, and this might contribute to the maintenance of cognitive function in patients undergoing hemodialysis.

Baseline serum albumin and its dynamic change is associated with type 2 diabetes risk: A large cohort study in China.

The study aimed to investigate the associations of baseline serum albumin level and its dynamic change with type 2 diabetes mellitus (T2DM) risk in a large Chinese cohort study. This cohort study included 30 442 adults without T2DM at first entry, who completed at least one follow-up of annual examinations between 2009 and 2016. Serum albumin level was measured at baseline and at every annual check-up. The dynamic change in serum albumin level (∆ALB) was calculated by subtracting serum albumin level at baseline from that at the last follow-up. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated with Cox regression models. During 7 years of follow-up, we identified 1634 T2DM events. From the lowest to the highest quartile of serum albumin level, adjusted HRs (95% CI) were 1.00 (reference), 0.96 (0.94, 1.01), 0.98 (0.95, 1.02) and 0.88 (0.85, 0.98), respectively. As compared with stable change in serum albumin (-0.2 ≤ ∆ALB <1.0 g/L), the risk of T2DM increased for ∆ALB < -2.0 g/L (HR 1.44, 95% CI 1.24-1.68) and decreased for ∆ALB ≥3.0 g/L (0.81, 0.68-0.97) after adjusting for potential confounding factors. Restricted cubic splines showed a linear dose-response association between baseline serum albumin level and T2DM risk (Pnonlinearity 0.715) and a nonlinear dose-response association between ∆ALB and T2DM risk (Pnonlinearity 0.011). Baseline serum albumin level appears to be inversely associated with T2DM risk. Adults with reduced serum albumin level could be early identified for diabetes risk in clinical practice.

Verification of serum albumin elevating effect of cell-free and concentrated ascites reinfusion therapy for ascites patients: a retrospective controlled cohort study

Cell-free and concentrated ascites reinfusion therapy (CART) is frequently used to treat refractory ascites in Japan. However, its efficacy remains unclear. This controlled cohort study verified the serum albumin elevating effect of CART by comparisons with simple paracentesis. Ascites patients receiving CART (N = 88) or paracentesis (N = 108) at our hospital were assessed for the primary outcome of change in serum albumin level within 3 days before and after treatment. A significantly larger volume of ascites was drained in the CART group. The change in serum albumin level was +0.08 ± 0.25 g/dL in the CART group and −0.10 ± 0.30 g/dL in the paracentesis group (P < 0.001). The CART – paracentesis difference was +0.26 g/dL (95%CI +0.18 to +0.33, P < 0.001) after adjusting for potential confounders by multivariate analysis. The adjusted difference increased with drainage volume. In the CART group, serum total protein, dietary intake, and urine volume were significantly increased, while hemoglobin and body weight was significantly decreased, versus paracentesis. More frequent adverse events, particularly fever, were recorded for CART, although the period until re-drainage was significantly longer. This study is the first demonstrating that CART can significantly increase serum albumin level as compared with simple paracentesis. CART represents a useful strategy to manage patients requiring ascites drainage.

Change in serum albumin level predicts short-term complications in patients with normal preoperative serum albumin after gastrectomy of gastric cancer.

The purpose of this study was to evaluate the correlation between serum albumin level change (ΔALB) and post-operative complications in patients with normal preoperative serum albumin after gastrectomy of gastric cancer. A total of 193 patients undergoing curative (R0) gastrectomy from September 2015 to May 2017 were enrolled in this study. The risk factors for predicting post-operative complications were identified by univariate and multivariate analysis. The cut-off value and diagnostic accuracy of ΔALB were measured by receiver operating characteristic curves. ΔALB was defined as: (albumin level before surgery - albumin on post-operative day (POD) 1)/albumin level before surgery × 100%. A total of 60 patients (31.0%) had post-operative complications. Our results showed that the cut-off value of ΔALB was 19.0%. Using a cut-off value of 19.0%, multivariate analysis identified that ΔALB was able to predict post-operative complications as an independent factor (odds ratio 13.98, 95% confidence interval 6.048-32.32, P < 0.001). In addition, the area under the curve of ΔALB is higher than C-reactive protein on POD 3 (0.773 versus 0633). Compared with patients with ΔALB <19.0%, patients with ΔALB ≥19.0% have higher risk of post-operative complications suffered (62.3 versus 13.7%, P < 0.001) and longer post-operative stay (22.1 ± 13.5 versus 17.5 ± 4.2, P < 0.001). ΔALB acted as an independent predictor in short-term complications for patients with normal preoperative serum albumin and its diagnostic accuracy was higher than C-reactive protein on POD 3. It is promising to be a precise and straight predictor for incidence of post-operative complications to patients with normal preoperative serum albumin.

Effect of non-surgical periodontal treatment on serum albumin levels in patients with chronic periodontitis.

Background Albumin is a protein whose serum levels decrease in inflammatory conditions such as periodontal diseases. This study was undertaken to evaluate changes in serum albumin levels in patients with and without periodontal diseases prior and subsequent to non-surgical periodontal treatment and its relationship with clinical parameters of periodontal disease. Methods Twenty patients diagnosed as having chronic periodontitis and 20 periodontally healthy subjects, referring to Tabriz Faculty of Dentistry, were selected. Serum albumin levels and clinical variables of periodontal disease (probing pocket depth, gingival index, bleeding index, clinical attachment level and plaque index) were determined before treatment and three months subsequent to non-surgical periodontal treatment. Data were subjected to descriptive statistical analyses (mean ± SD). Serum levels of albumin and clinical parameters were compared between the two groups with independent-samples t-test. Paired-samples t-test was applied to compare the variables before and after treatment in the case group. Statistical significance was defined at P<0.05. Results The mean serum albumin level of chronic periodontitis patients (3.62±0.11 mg/dL) exhibited a significantly lower value compared to subjects who were periodontally healthy (4.17±0.29 mg/dL), with the serum albumin levels increasing significantly three months postoperatively (3.78±0.33 mg/dL), approaching the level in subjects who were periodontally healthy (P<0.05). Conclusion Decreases and increases in serum albumin levels under the effect of periodontal disease and its treatment indicated an inverse relationship between the albumin levels of serum and chronic periodontitis.