Hypoalbuminemia Patients Research Articles

Impact of Preoperative Serum Albumin Level on the Outcome of Colorectal Cancer Surgery.

Background Gastrointestinal malignancy surgeries are known to have a risk of postoperative complications. Preoperative nutritional status has been suggested as a potential predictor of postoperative outcomes, with low serum albumin levels utilized as a marker of malnutrition and increased risk of postoperative complications. This paper investigated the association between preoperative serum albumin levels and postoperative outcomes in patients undergoing colorectal cancer surgery. Methods This retrospective data-maintained study was based on all patients aged 18 years and above who underwent colorectal cancer surgery at King Abdulaziz Medical City, Riyadh, Saudi Arabia between 2015 and 2022. Results A total of 400 patients were included in the study. With an average age of 64.43 years. Males represented 254 (63%) of the patients, while females accounted for 146 (37%). Thirty percent of patients had hypoalbuminemia (i.e., albumin level below 35 g/L) before surgery. Among the sample, 112 (28%) experienced complications after surgery. The mean albumin level for patients who experienced postoperative complications was 30.46 g/L while patients without complications had a normal albumin level. As for the length of hospital stay, it was eight days for patients with a normal albumin level and 23 days for hypoalbuminemia patients. Conclusion In conclusion, preoperative hypoalbuminemia is associated with poor patient outcomes and can be utilized as a prognostic marker for patients in need of colorectal cancer surgery.

Association between admission albumin levels and 30-day readmission after hip fracture surgery in geriatric patients: a propensity score-matched study

PurposeThis study aimed to evaluate the correlation admission albumin levels and 30-day readmission after hip fracture surgery in geriatric patients.MethodsIn this retrospective cohort study, 1270 geriatric patients admitted for hip fractures to a level I trauma center were included. Patients were stratified by clinical thresholds and albumin level quartiles. The association between admission albumin levels and 30-day readmission risk was assessed using multivariate logistic regression and propensity score-matched analyses. The predictive accuracy of albumin levels for readmission was evaluated by ROC curves. The dose–response relationship between albumin levels and readmission risk was examined. ResultsThe incidence of 30-day readmission was significantly higher among hypoalbuminemia patients than those with normal albumin levels (OR = 2.090, 95%CI:1.296–3.370, p = 0.003). Furthermore, propensity score-matched analyses demonstrated that patients in the Q2(35.0–37.9 g/L) (OR 0.621, 95%CI 0.370–1.041, p = 0.070), Q3(38.0–40.9 g/L) (OR 0.378, 95%CI 0.199–0.717, p < 0.001) and Q4 (≥ 41 g/L) (OR 0.465, 95%CI 0.211–0.859, p = 0.047) quartiles had a significantly lower risk of 30-day readmission compared to those in the Q1(< 35 g/L) quartile. These associations remained significant after propensity score matching (PSM) and subgroup analyses. Dose–response relationships between albumin levels and 30-day readmission were observed.ConclusionsLower admission albumin levels were independently associated with higher 30-day readmission rates in elderly hip fracture patients. Our findings indicate that serum albumin may assist perioperative risk assessment, and prompt correction of hypoalbuminemia and malnutrition could reduce short-term readmissions after hip fracture surgery in this high-risk population.

The role of serum albumin in critical illness, predicting poor outcomes, and exploring the therapeutic potential of albumin supplementation.

Serum albumin (ALB) plays a vital role in maintaining oncotic pressure and contributing to hemodynamic stability, with low levels associated with adverse outcomes in critically ill patients. This study aimed to assess the association between serum ALB concentrations and poor outcomes and the possible benefits of ALB supplementation. A retrospective study involving 300 intensive care unit (ICU) patients. Albumin levels were recorded upon admission and throughout the stay, and patients were categorized based on a cutoff of 2.49 g/dl. The associations between low ALB levels and mortality were assessed using regression analysis. Additionally, it investigated the association of albumin supplementation with patient outcomes and mortality in specific patient populations. The mean age was 54.9 years, with 68% having sepsis. Patients with low baseline ALB concentrations exhibited higher overall mortality (71% vs. 52%) and 28-day mortality (50% vs. 39%). Adjusted analyses confirmed associations with mortality. Albumin supplementation was administered to 53% of the patients. Its use demonstrated potential benefits, particularly in reducing mortality, when given to specific groups, such as sepsis and hypoalbuminemia patients. The study confirms that low serum albumin levels are strongly associated with higher mortality rates in ICU patients. Albumin supplementation showed potential benefits, particularly in patients with sepsis and low albumin levels. Further analyses explored the dosage-response relationship and identified potential groups that would benefit from albumin supplementation. Albumin can play a major role in predicting mortality in critically ill patients. Moreover, ALB supplementation may improve survival, especially in resource-limited settings. Future research should refine protocols through clinical trials for optimal survival in critically ill patients.

Preoperative Serum Albumin as Predictor of Outcomes After Thyroidectomy.

Albumin is considered to be a surrogate marker for inflammation and nutritional status. Levels usually decrease after surgery but little is known about the predictive value of preoperative albumin levels in patients undergoing thyroidectomy. This study aimed to investigate the 30-day incidence of postoperative outcomes in thyroidectomy patients with and without preoperative hypoalbuminemia. Retrospective cohort study. TriNetX Database. TriNetX, a federated deidentified database, was retrospectively queried to identify patients who underwent thyroidectomy. Postoperative outcomes within 30 days of thyroidectomy, based on International Classification of Disease, 10th Revision and Current Procedural Terminology codes, in patients with preoperative hypoalbuminemia (≤3.4 g/dL) (cohort 1) were analyzed and compared to patients without hypoalbuminemia (cohort 2). After propensity score matching, 2398 patients were identified in each cohort. Hypoalbuminemia patients were more likely to have postoperative pneumonia (odds ratio, OR: 3.472, 95% confidence interval, CI [2.016-5.978]), acute renal failure (OR: 3.872, 95% CI [2.412-6.217]), venous thromboembolism (OR: 1.766, 95% CI[1.016-2.819]), and surgical site infection (OR: 2.353, 95% CI [1.282-4.32]). Rates of recurrent laryngeal nerve injury were comparable between cohorts. Patients undergoing thyroidectomy with preoperative hypoalbuminemia have a higher prevalence of postoperative complications compared to patients without preoperative hypoalbuminemia. While not routinely assessed, preoperative evaluation of serum albumin levels may help guide expectations and optimal management of thyroidectomy patients.

Hypoalbuminemia improves the ACS-NSQIP surgical risk calculator for gastrectomy

BackgroundThe ACS-NSQIP Surgical Risk Calculator (SRC) is used to predict surgical outcomes, but its accuracy in gastrectomy has been questioned.1,2 We investigated if adding hypoalbuminemia enhances its predictive ability in gastrectomy. MethodsWe identified gastrectomy patients from the ACS-NSQIP database from 2005 to 2019. We constructed pairs of logistic regression models: one with the existing 21 preoperative risk factors from the SRC and another with the addition of hypoalbuminemia. We evaluated improvement using Likelihood Ratio Test (LRT), Brier scores, and c-statistics. ResultsOf 18,070 gastrectomy patients, 34.5 ​% had hypoalbuminemia. Hypoalbuminemia patients had 2.34 higher odds of mortality and 1.79 higher odds of morbidity. Adding hypoalbuminemia to the RC model statistically improved predictions for mortality, cumulative morbidity, pulmonary, renal, and wound complications (LRT p ​< ​0.001). It did not improve predictions for cardiac complications (LRT p ​= ​0.11) ConclusionHypoalbuminemia should be considered as an additional variable to the ACS-NSQIP SRC for gastrectomy.

Hypoalbuminemia in burn patients with COVID-19: a cross-sectional study

Link of Video Abstract: https://youtu.be/onpoWqpxn5Q Background: Burns contributes substantially to illness and death rates in underdeveloped nations. Hypoalbuminemia is a medical disorder that has been observed in both burn patients and individuals diagnosed with COVID-19. Hypoalbuminemia has been observed to exacerbate the severity of burn injuries and potentially COVID-19 infections. This retrospective study aimed to examine the disparity in hypoalbuminemia occurrence and its association with mortality among burn patients, specifically focusing on those infected with and without COVID-19. Methods: The present investigation is a retrospective cross-sectional study examining the disparities in hypoalbuminemia occurrence and its association with mortality among burn patients with or without COVID-19. The study was conducted at Dr. Soetomo General Hospital in Surabaya, covering the time frame from March 2020 to December 2022. Results: Among a cohort of 225 individuals who presented with acute phase burns, both with and without COVID-19, a total of 125 patients (57.1%) were seen to develop hypoalbuminemia during their treatment at Dr. Soetomo General Hospital between March 2020 and December 2022. This study found no statistically significant disparity in mean albumin levels and mortality outcomes between acute-phase burn patients with COVID-19 and those without COVID-19 who experienced hypoalbuminemia. Nevertheless, notable disparities (p&lt;0.05) were seen in terms of age, length of stay (LOS), and severity of burns among hypoalbuminemia patients who were discharged from the hospital (KRS) for outpatient care and those who succumbed to their condition. Conclusion: Our findings indicate no statistically significant disparity in albumin levels and mortality rates among burn patients, regardless of whether they are also diagnosed with COVID-19. Nevertheless, variables such as age, length of stay (LOS), and burn area exhibit notable variations in the outcome of death.

Preoperative Hypoalbuminemia and Development of Surgical Site Infection and Anastomotic Leakage in Emergency Colorectal Surgery

Background: Although hypoalbuminemia is a well-known predictor of postoperative complications, including surgical site infection (SSI) and anastomotic leakage (AL) in gastrointestinal surgery patients, which requires necessary interventions before surgery, there is limited opportunity for preoperative optimization and intervention in emergency colorectal surgeries. Objectives: Therefore, this study aimed to assess the relationship between preoperative serum albumin levels and the development of SSI and AL in emergency colorectal surgery patients. Methods: In this cohort study, patients who underwent emergency colorectal surgery during 17 months, were assessed. Albumin level was measured before surgery, and patients were followed for 1 month after surgery to identify the development of SSI and AL. Results: In total, 173 patients were enrolled in the study, but data analysis was performed on 170 patients. They were divided into hypoalbuminemia group (n=98, 57.6%) and non-hypoalbuminemia group (n=72, 42.4%). The mean ages of patients in each group were 57.17±16.19 and 51.61±16.14 years old, respectively (P=0.028). The AL was observed in 4 (2.4 %) patients; 3 patients in the hypoalbuminemia group and one patient in the non-hypoalbuminemia group (P=0.205, relative risk=2.33, 95% CI: 0.42-12.82). The SSI was observed in 13 patients (7.6%) during the 1-month follow-up; 8 patients (5.1%) had superficial SSI and 5 (3.2%) had deep ones. Albumin level was significantly lower in patients with AL (2.9±0.48), compared to those without AL (3.6±0.7 g/dL). Moreover, albumin level was higher in patients with SSI (3.11±0.62), compared to patients without SSI (3.6±0.7 g/dL). The incidence of complications, either AL or SSI, was significantly higher in hypoalbuminemia patients, compared to non-hypoalbuminemia patients (P=0.017, Odds Ratio=4.24, 95% CI: 1.29-13.9). Adjusted OR for age was 3.82 (95% CI: 1.15-12.75, P=0.029); therefore, a 13.5% reduction in OR indicated that age is a confounding factor. Conclusion: Preoperative hypoalbuminemia was significantly associated with post-development of complications in emergency colorectal surgery and older age and lower preoperative albumin levels may serve as valuable indicators for the identification of patients at higher risk of complications.

Albumin infusion may decrease the mortality of hypoalbuminemia patients with severe acute pancreatitis: a retrospective cohort study

BackgroundAt present, the relationship between severe acute pancreatitis (SAP) and albumin infusion is not clear. We aimed to identify the impact of serum albumin on the prognosis of SAP and the association between albumin infusions and mortality for hypoalbuminemia patients.MethodsThis was a retrospective cohort study that analyzed 1000 patients with SAP who were admitted to the First Affiliated Hospital of Nanchang University between January 2010 and December 2021 using data from a prospectively maintained database. Multivariate logistic regression analysis was conducted to reveal the relationship between serum albumin within 1 week after admission and poor prognosis of SAP. Propensity score matching (PSM) analysis was adopted to evaluate the effect of albumin infusion for hypoalbuminemia patients with SAP.ResultsThe prevalence of hypoalbuminemia (≤ 30 g/L) was 56.9% within 1 week after admission. Multivariate logistic regression identified that age (OR: 1.02; 95% CI: 1.00-1.04; P = 0.012), serum urea (OR: 1.08; 95% CI: 1.04–1.12; P < 0.001), serum calcium (OR: 0.27; 95% CI: 0.14–0.50; P < 0.001), lowest albumin level within 1 week after admission (OR: 0.93; 95% CI: 0.89–0.97; P = 0.002), and APACHE II score ≥ 15 (OR: 1.73; 95% CI: 1.19–2.51; P = 0.004) were independently associated with mortality. The PSM analysis demonstrated that mortality (OR: 0.52, 95% CI: 0.29–0.92, P = 0.023) was less common in albumin-infused than non-albumin-infused hypoalbuminemia patients. In subgroup analyses, doses > 100 g within 1 week after admission for hypoalbuminemia patients with albumin infusions was associated with lower mortality than doses ≤ 100 g (OR: 0.51, 95% CI: 0.28–0.90, P = 0.020).ConclusionsHypoalbuminemia in early-stage SAP is significantly related to poor prognosis. However, albumin infusions could significantly decrease mortality in hypoalbuminemia patients with SAP. Additionally, infusing sufficient albumin within a week after admission may decrease mortality in hypoalbuminemia patients.

Effect of Hypoalbuminemia in Patients Undergoing Parathyroidectomy for Primary Hyperparathyroidism.

Treatment for primary hyperparathyroidism is parathyroidectomy. This study identifies the association between hypoalbuminemia (HA) and outcomes in patients undergoing parathyroidectomy for primary hyperparathyroidism. This retrospective cohort analysis utilized the 2006-2015 National Surgical Quality Improvement Program database. Current Procedure Terminology codes were used to identify patients undergoing parathyroidectomy for primary hyperparathyroidism. Prolonged length of stay (LOS) was defined as a duration of 2 days or greater. Demographics and comorbidities were compared between HA (serum albumin <3.5 g/dL) and non-HA cohorts using chi-square analysis. The independent effect of HA on adverse outcomes was analyzed using binary logistic regression. A total of 7183 cases with primary hyperparathyroidism were classified into HA (n = 381) and non-HA (n = 6802) cohorts. HA patients had increased complications, including renal insufficiency (0.8% vs. 0.0%, p = 0.001), sepsis (1.0% vs. 0.1%, p = 0.003), pneumonia (0.8% vs. 0.1%, p = 0.018), acute renal failure (1.0% vs. 0.0%, p < 0.001), and unplanned intubation (1.3% vs. 0.2%, p = 0.004). HA patients had increased risk of death (1.6% vs. 0.1%, p < 0.001), prolonged LOS (40.9% vs. 6.3%, p < 0.001), and any complication (5.5% vs. 1.2%, p < 0.001). Adjusted binary logistic regression indicated HA patients experienced increased odds of progressive renal insufficiency (OR 18.396, 95% CI 1.844-183.571, p = 0.013), prolonged LOS (OR 4.892; 95% CI 3.571-6.703; p < 0.001), unplanned reoperation (OR 2.472; 95% CI 1.012-6.035; p = 0.047), and unplanned readmission (OR 3.541; 95% CI 1.858-6.748; p < 0.001). HA may be associated with adverse complications in patients undergoing parathyroidectomy for primary hyperparathyroidism. 3 Laryngoscope, 133:2035-2039, 2023.

Preoperative Hypoalbuminemia Not Associated With Total Ankle Arthroplasty Outcomes.

This study aims to investigate the effect of hypoalbuminemia on the rates of 30-day complication, readmission, and reoperation following total ankle arthroplasty (TAA). The American College of Surgeons National Surgical Quality Improvement Program database was queried from 2007 to 2019 to identify 710 TAA patients. Patients were then stratified into normal (n = 673) or low (n = 37) albumin groups. Demographics, medical comorbidities, concomitant procedures, hospital length of stay, and 30-day complication, readmission, and reoperation rates were compared between groups. Preoperative serum albumin level was also used as a continuous variable when analyzing postoperative outcomes. The overall cohort was predominantly male (51.5%), and the mean age was 65.02 (range, 45-87) years. We found there to be no statistically significant difference in demographics between cohorts. However, hypoalbuminemia patients were significantly more likely to use long-term steroids for a chronic condition (normal = 6.1%, low = 18.9%; P = .009). Additionally, there was no difference in 30-day complication (normal = 3.0%, low = 0.0%; P = .618), readmission (normal = 2.4%, low = 0.0%; P = .632), and reoperation (normal = 1.0%, low = 0.0%; P = 1.000) rates between groups. The results of this study show that malnourished patients are not at an increased risk of 30-day complication, readmission, or reoperation following TAA despite having a worse preoperative comorbidity profile. Level III, Retrospective cohort study.

Low Preoperative Albumin Associated With Increased Risk of Superficial Surgical Site Infection Following Midfoot, Hindfoot, and Ankle Fusion.

This study investigates the effect of malnutrition, defined by hypoalbuminemia, on rates of complication, readmission, reoperation, and mortality following midfoot, hindfoot, or ankle fusion. The National Surgical Quality Improvement Program (NSQIP) database was queried from 2005 to 2019 to identify 500 patients who underwent midfoot (n = 233), hindfoot (n = 261), or ankle (n = 117) fusion. Patients were stratified into normal (n = 452) or low (n = 48) albumin group, which was defined by preoperative serum albumin level <3.5 g/dL. Demographics, medical comorbidities, hospital length of stay (LOS), and 30-day complication, readmission, and reoperation rates were compared between groups. The mean age of the cohort was 58.7 (range, 21-89) years. Hypoalbuminemia patients were significantly more likely to have diabetes (P < .001), be on dialysis (P < .001), and be functionally dependent (P < .001). The LOS was significantly greater among the low albumin group (P < .001). The hypoalbuminemia cohort also exhibited a significantly increased likelihood of superficial infection (P = .048). Readmission (P = .389) and reoperation (P = .611) rates did not differ between the groups. This study shows that malnourished patients have an increased risk of superficial infection following foot and ankle fusions but are not at an increased risk of readmission or reoperation, suggesting that low albumin confers an elevated risk of surgical site infection. Level III, Retrospective cohort study.

Occurrence of hypoalbuminemia in cases of rhino-orbito-cererbral mucormycosis and its relationship with the disease severity according to staging, a tertiary care center-based study

Background: Mucormycosis is a serious but rare fungal infection with increasing incidence of rhino-orbito-cerebral mucormycosis (ROCM) in the setting of COVID-19. Some studies have shown presence of hypoalbuminemia in cases of mucormycosis, which can affect the prognosis, outcome, and also the drug toxicity in a significant way. A staging of ROCM was proposed and is being used widely based on clinical symptoms and signs, evaluation, and diagnosis. Aims and Objectives: Our objective was to look for any relationship between two factors, occurrence of hypoalbuminemia and severity of ROCM according to staging. Materials and Methods: The study was a hospital-based prospective cross-sectional study done on 41 ROCM patients. All patients of diagnosed ROCM were included by complete enumeration method. Serum albumin of every patient was measured using standard biochemical procedures and patients were divided into groups of normoalbuminemia (Serum albumin level &gt;3.5 gm/dl), mild hypoalbuminemia (Serum albumin level 2.5–3.5 gm/dl), and severe hypoalbuminemia (Serum albumin level &lt;2.5 gm/dl). All the patients were divided into Stage 1, 2, 3, and 4 according to severity of ROCM. Then, the occurrence of hypoalbuminemia was calculated among the patients and correlation between ROCM stages and severity of hypoalbuminemia was measured using standard statistical tools. Results: Among the patients of ROCM, 15% patients did not develop any hypoalbuminemia. About 51% developed mild hypoalbuminemia and 34% developed severe hypoalbuminemia. Maximum number of severe hypoalbuminemia patients were found in the Stage 3 group [total 6 (35%)], but the incidence of the same was maximum in the Stage 4 group (56%). Mild hypoalbuminemia is most common (10) and also most prevalent in the Stage 3 group (59%). Conclusion: We found out that serum albumin level is significantly affected by ROCM severity, that is, more severe the disease, more chance to develop hypoalbuminemia.

Pre-operative hypoalbuminemia: overlooked prior knee arthroplasty?

&lt;p class="BodyA"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Role of preoperative serum albumin on primary total knee arthroplasty.&lt;/p&gt;&lt;p class="BodyA"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A total of 1022 patients who underwent primary knee arthroplasty were collected. All patients were divided into the control group (preoperative serum albumin ≥3.5 g/dl) and case group (preoperative serum albumin &amp;lt;3.5 g/dl). The risk factors of preoperative hypoalbuminemia and the postoperative complications were analyzed.&lt;/p&gt;&lt;p class="BodyA"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Compared to controls, hypoalbuminemia patients were older (p&amp;lt;0.05 ), had higher risk for any complication such as delayed wound healing, pleural effusion, and pneumonia, lower BMI and longer hospital stay (p&amp;lt;0.001).&lt;/p&gt;&lt;p class="BodyA"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Preoperative hypoalbuminemia is more frequent in patients who are older, have poor nutritional condition, and have more than two concurrent disorders. Hypoalbuminemia before surgery is linked to a higher risk of postoperative problems.&lt;/p&gt;

Prevalence of Spontaneous Bacteria Peritonitis in Patients with Hypoalbuminemia and Cirrhosis

Background and Aim: Spontaneous bacterial peritonitis (SBP) is one of the most serious complications of ascites, resulting in liver cirrhosis infection, accounting for approximately 25% of all bacterial infections. Within a diagnostic year, the mortality rate for spontaneous bacterial peritonitis ranges from 30% to 90%. The current study attempted to determine the prevalence of spontaneous bacterial peritonitis in patients with hypoalbuminemia and cirrhosis. Materials and Methods: This cross-sectional study was conducted on 112 cirrhosis with hypoalbuminemia patients at Medical Unit A, Hayatabad Medical Complex Peshawar and department of Gastroenterology AK CMH / Sheikh Khalifa bin Zaid Al Nahyan Hospital, Rawalakot Azad Kashmir. The duration of the study was six months from 5th January 2021 to 5th June 2021. All patients of either gender with liver cirrhosis and hypoalbuminemia aged 20 to 60 years were included in the study. Each individual was asked to provide written informed consent. Each patient's creatinine, albumin, and sodium levels were measured in the laboratory using urine and blood sample tests. Each patient's absence or presence of SBP was recorded according to the operational definition. For data analysis, SPSS version 20 was used. Results: Of the total 112 patients, 59 (52.7%) were male and 53 (473%) were female. The overall mean age of the patients was 43.51±4.58 years whereas male and female patients had 47.36±5.62 and 39.66±3.54 years respectively. The number of patients falling in class B and Child Push class C was 50 (44.6%) and 62 (55.4%) respectively. The prevalence of spontaneous bacterial peritonitis was 48 (42.9%). Out of 48 SBP patients, 29 (60.4%) were male and 19 (39.6%) were female. The prevalence of SBP was seen in 13 (27.1%) cases of Class B and 35 (72.9%) of Class C (Child-Pugh Class) respectively. Hypertension and diabetes mellitus as comorbidities were present in 11 (9.8%) and 25 (22.3%) cases respectively. Conclusion: In the current study, the prevalence of SBP was 42.9%. Our study revealed a higher prevalence of spontaneous bacterial peritonitis in cirrhosis patients. Also, a significant association has been found between spontaneous bacterial peritonitis and child Pugh Class C and Class B whereas SBP had no substantial connotation with gender, etiology, and even age but with disease duration. Keywords: Cirrhosis; Spontaneous Bacterial Peritonitis; Hypoalbuminemia

The effect of preoperative hypoalbuminemia on complications after primary hip arthroplasty

ObjectivesTo explore the risk factors of preoperative hypoalbuminemia and its’ effects on complications in the elderly with primary hip arthroplasty.MethodsA total of 211 elderly inpatients who underwent hip arthroplasty were collected. All patients were divided into the control group (preoperative serum albumin ≥35 g/L) and case group (preoperative serum albumin <35 g/L). The risk factors of preoperative hypoalbuminemia and the postoperative complications were analyzed.ResultsCompared to controls, hypoalbuminemia patients were older (P = 0.026), had lower BMI (P = 0.045), higher cardiac function score (P < 0.0001), higher ASA scores (P = 0.023), and longer hospital stay (P < 0.001). The intraoperative albumin loss in the case group was significantly higher than that of in control group (P < 0.001), but there was no significant difference in operation time and intraoperative blood loss between the two groups (P >0.05). Compared to controls, hypoalbuminemia patients had a higher risk for any complication (P = 0.014), such as delayed wound healing, pleural effusion, and pneumonia. The risk of postoperative complications increased by 6.9% with every 1 year old is increasing (age > 60). The risk of postoperative complications in the case group was 1.89 times higher than that in the control group.ConclusionPatients with older age, poor nutritional status, and more than 2 concomitant diseases are more likely to develop preoperative hypoalbuminemia. Preoperative hypoalbuminemia is related to the increased incidence of postoperative complications. Perioperative albumin loss is not only due to perioperative blood loss, but also related to vascular permeability and abnormal albumin metabolism.

Hypoalbuminemia Predicts Serious Complications Following Elective Bariatric Surgery.

The aims of this study were to (1) characterize the prevalence of hypoalbuminemia (HA), (2) compare complication rates among HA and non-HA patients, and (3) determine the influence of HA on postoperative complications and 30-day mortality among bariatric surgery patients. Data was extracted from the MBSAQIP registry from 2015 to 2018. A presurgical serum albumin level of [Formula: see text] 3.5g/dL was used to organize the patient population into HA and non-HA cohorts. Bivariate analysis and multivariable logistic regression modeling were used. Of 590,971 patients, 42,618 (7.2%) were identified as having serum albumin levels [Formula: see text] 3.5g/dL. HA patients were younger (44.0 + / - 11.9 vs. 44.5 + / - 12.0years; p < 0.0001), were of increased BMI (48.5 + / - 9.0kg/m2 vs. 45.1 + / - 7.7kg/m2; p < 0.0001), and had a lower baseline functional status (1.6% vs. 1.0% dependent or partially dependent; p < 0.0001). HA patients had more anastomotic leaks (0.46% vs. 0.38%; p = 0.02), deep surgical site infections (0.37% vs. 0.24%; p < 0.0001), and composite serious complications (4.4% vs. 3.3%; p < 0.0001). At 30-day post-operation, complications including need for reintervention (1.6% vs. 1.2%; p < 0.0001), readmission (4.8% vs. 3.7%; p < 0.0001), and mortality (0.14% vs. 0.086%; p = 0.001) were all more prevalent among HA patients. After functional status, HA was the strongest modifiable predictor of serious complications but was not predictive of 30-day mortality. We identified HA as one of the greatest modifiable factors predictive of serious complications. Adoption of strategies to identify and improve preoperative serum albumin levels may reduce overall serious complications among elective bariatric surgery patients.

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

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

Role of Nutrition therapy during COVID 19

Nutrition is a vital element of health. More decisively, nutrition is part of the treatment routine for acute and chronic diseases and applies mainly to conditions for which an etiologic treatment has not yet been discovered. Ebola virus outbreak Western Africa in the 2014–2016 proved that immediate supportive care significantly reduces case mortality rates [1]. This may relate as well to the current COVID-19 pandemic that is disturbing the world. Emerging evidence shows that COVID-19 is associated with negative outcomes in older, comorbid, and hypoalbuminemia patients. These features are not specific to the Chinese residents because they have been testified also in North American patients with COVID-19. When measured together, the emerging literature on patients with COVID-19 indirectly highlights the applicability of nutrition in possibly determining their outcomes. Older age and the presence of comorbid conditions are almost consistently associated with impaired nutritional status and sarcopenia, independently of body mass index. Fascinatingly, a high body mass index score appears to be related to a poor prognosis in comorbid patients with COVID-19, which further points to a possible role of sarcopenic obesity in influencing the outcome [2].

A Short Review Article – Role of Nutrition Therapy during COVID – 19

Nutrition is a vital element of health. More decisively, nutrition is part of the treatment routine for acute and chronic diseases and applies mainly to conditions for which an etiologic treatment has not yet been discovered. Ebola virus outbreak Western Africa in the 2014–2016 proved that immediate supportive care significantly reduces case mortality rates [1]. This may relate as well to the current COVID-19 pandemic that is disturbing the world. Emerging evidence shows that COVID-19 is associated with negative outcomes in older, comorbid, and hypoalbuminemia patients. These features are not specific to the Chinese residents because they have been testified also in North American patients with COVID-19. When measured together, the emerging literature on patients with COVID-19 indirectly highlights the applicability of nutrition in possibly determining their outcomes. Older age and the presence of comorbid conditions are almost consistently associated with impaired nutritional status and sarcopenia, independently of body mass index. Fascinatingly, a high body mass index score appears to be related to a poor prognosis in comorbid patients with COVID-19, which further points to a possible role of sarcopenic obesity in influencing the outcome [2].

A prediction model of contrast-associated acute kidney injury in patients with hypoalbuminemia undergoing coronary angiography

BackgroundRisk stratification is recommended as the key step to prevent contrast-associated acute kidney injury (CA-AKI) among at-risk patients following coronary angiography (CAG) and/or percutaneous coronary intervention (PCI). Patients with hypoalbuminemia are prone to CA-AKI and do not have their own risk stratification tool. Therefore, this study developed and validated a new model for predicting CA-AKI among hypoalbuminemia patients CAG/PCI.Methods1272 patients with hypoalbuminemia receiving CAG/PCI were enrolled and randomly allocated (2:1 ratio) into the development cohort (n = 848) and the validation cohort (n = 424). CA-AKI was defined as an increase of ≥0.3 mg/dL or 50% in serum creatinine (SCr) compared to baseline in the 48 to 72 h after CAG/PCI. A prediction model was established with independent predictors according to stepwise logistic regression, showing as a nomogram. The discrimination of the new model was evaluated by the area under the curve (AUC) and was compared to the classic Mehran CA-AKI model. The Hosmer-Lemeshow test was conducted to assess the calibration of our model.ResultsOverall, 8.4% (71/848) patients of the development group and 11.2% (48/424) patients of the validation group experienced CA-AKI. A new nomogram included estimated glomerular filtration rate (eGFR), serum albumin (ALB), age and the use of intra-aortic balloon pump (IABP); showed better predictive ability than the Mehran score (C-index 0.756 vs. 0.693, p = 0.02); and had good calibration (Hosmer–Lemeshow test p = 0.187).ConclusionsWe developed a simple model for predicting CA-AKI among patients with hypoalbuminemia undergoing CAG/PCI, but our findings need validating externally.Trial registrationhttp://www.ClinicalTrials.gov NCT01400295, retrospectively registered 21 July 2011.