Initial Serum Albumin Levels Research Articles

Clinical characteristics of membranous nephropathy with spontaneous remission: An analysis of 24 patients

PurposeTo investigate the prognosis of patients with spontaneous remission (SR) of phospholipase A2 receptor (PLA2R)-associated membranous nephropathy (MN). Patients and methodsPatients diagnosed with MN were recruited after examining their renal biopsy in the Renal Department of China-Japan Friendship Hospital between January 2015 and September 2021. Among them, 24 patients with SR were included in this study and follow-up. ResultsTwenty-four patients diagnosed with SR of PLA2R-associated MN were recruited; 11 were male, and 13 were female, with a mean age of 49.5±14.5 years (range, 30–77 years). The initial 24-hour urinary total protein and serum albumin levels were 0.29±0.14g/d and 37.5±4.4g/L, respectively, and the initial serum creatinine was 65.0±15.8μmol/L. During the follow-up of 33.9±19.1 months (range, 6–73 months), 22 (91.7%) patients maintained remission; however, one patient had impaired renal function due to acute coronary syndrome and coronary angiography findings, and one patient experienced a repeated relapse caused by respiratory tract infection, at 50 and 70 months. A systematic review of the relevant literature was conducted, and records of patients with SR of PLA2R-associated MN were retrieved from 16 case reports or case series with a total of 97 cases. ConclusionsMost patients with SR of MN had a promising long-term prognosis, with only a few cases of relapse.

Clinical characteristics of membranous nephropathy with spontaneous remission: An analysis of 24 patients

PurposeTo investigate the prognosis of patients with spontaneous remission (SR) of phospholipase A2 receptor (PLA2R)-associated membranous nephropathy (MN). Patients and methodsPatients diagnosed with MN were recruited after examining their renal biopsy in the Renal Department of China-Japan Friendship Hospital between January 2015 and September 2021. Among them, 24 patients with SR were included in this study and follow-up. ResultsTwenty-four patients diagnosed with SR of PLA2R-associated MN were recruited; 11 were male, and 13 were female, with a mean age of 49.5±14.5 years (range, 30–77 years). The initial 24-hour urinary total protein and serum albumin levels were 0.29±0.14g/d and 37.5±4.4g/L, respectively, and the initial serum creatinine was 65.0±15.8μmol/L. During the follow-up of 33.9±19.1 months (range, 6–73 months), 22 (91.7%) patients maintained remission; however, one patient had impaired renal function due to acute coronary syndrome and coronary angiography findings, and one patient experienced a repeated relapse caused by respiratory tract infection, at 50 and 70 months. A systematic review of the relevant literature was conducted, and records of patients with SR of PLA2R-associated MN were retrieved from 16 case reports or case series with a total of 97 cases. ConclusionsMost patients with SR of MN had a promising long-term prognosis, with only a few cases of relapse.

Infusion of Human Albumin on Acute Pancreatitis Therapy: New Tricks for Old Dog?

Objective: Human serum albumin (HSA) infusion is a common administration on acute pancreatitis therapy in the Intensive Care Unit (ICU), but its actual association with patients’ outcomes has not been confirmed. The study is aimed to determine whether the in-hospital prognosis of ICU patients with acute pancreatitis could benefit from HSA. Methods: 950 acute pancreatitis patients diagnosed in 2008–2019 were extracted from the MIMIC-IV database as our primary study cohort. The primary outcome was in-hospital mortality. We also performed an external validation with a cohort of 104 acute pancreatitis patients after PSM matching from the eICU database. Results: In MIMIC-IV, 228 acute pancreatitis patients received HSA infusion (Alb group) during their hospitalization, while 722 patients did not (non-Alb group). Patients in the Alb group presented a poorer survival curve than the non-Alb group, while this difference disappeared after PSM or IPTW matching (log-rank test: PSM: p = 0.660, IPTW: p = 0.760). After including covariates, no association was found between HSA infusion and patients’ in-hospital mortality before and after matching (original cohort: HR: 1.00, 95% CI: 0.66–1.52, p = 0.998). HSA infusion also did not benefit patients’ 28-days or ICU mortality, while it was significantly associated with a longer duration of hospital and ICU. In addition, the initial serum albumin levels, infections, the total amount, or the initial timing of infusion did not affect the conclusion. Similarly, in the eICU cohort, HSA infusion was still not a beneficial prognostic factor for patients’ in-hospital prognosis (p = 0.087). Conclusion: Intravenous human serum albumin infusion could not benefit acute pancreatitis patients’ in-hospital prognosis and was associated with prolonged hospital and ICU duration.

Clinical features and outcomes of 76 patients with COVID-19-related multi-system inflammatory syndrome in children.

ObjectivesMulti-system inflammatory syndrome in children (MIS-C) is a less understood and a rare complication of coronavirus disease-2019 (COVID-19). Given the scarce data regarding this novel disease, we aimed to describe the clinical features and outcomes of our patients with MIS-C and to evaluate the associated factors for the pediatric intensive care unit (PICU) admission.MethodsThe MIS-C patients under 18 years old diagnosed and treated in three referral centers between July 2020 and March 2021 were included. Data of the patients were retrospectively obtained from their medical records.ResultsOverall, 76 subjects (24 females) with a mean age of 8.17 ± 4.42 years were enrolled. Twenty-seven (35.5%) patients were admitted to the PICUs. The two most common systemic involvement patterns were cardiac and gastrointestinal. There was only one lethal outcome in a patient with underlying acute lymphoblastic leukemia. Those with higher procalcitonin levels at admission were found to stay longer in the hospital (r = 0.254, p = 0.027). The risk of PICU admission increased with age (aOR: 1.277; 95% CI: 1.089–1.498; p = 0.003) and with decreased initial serum albumin levels (aOR: 0.105; 95% CI: 0.029–0.378; p = 0.001).ConclusionAlthough there is a wide clinical variability among the patients with MIS-C, we suggest that those with older age and lower initial serum albumin levels merit close monitoring due to their higher risk for PICU admission. Key Points• Although there is a wide variability regarding the management process among clinicians, MIS-C is a rare, severe, less understood complication of COVID-19 that may cause rapid clinical deterioration in the patients.• Clinicians should be aware of this condition in children with persistent fever and a family history of COVID-19.• Older age and low serum albumin levels are the independent predictors for the pediatric intensive care unit admission among MIS-C patients.

Predictors of Relapse in Idiopathic Nephrotic Syndrome in Children Presenting to a Tertiary Center

Background and Aim: Idiopathic nephrotic syndrome (INS) is a disease of relapse and remission in children in which about 20-30% of the patients may experience a single episode in their lives while the rest suffer from relapse. Some factors contribute to relapse. The objective of this study was to explore the predictors of relapse in INS.Methods: A prospective longitudinal study was conducted in the Department of Pediatric Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU) from September 2015 to August 2016. One hundred and ten patients with the first episode of INS were uninterruptedly enrolled in this study. After screening and subsequent confirmatory diagnosis, the patients were treated with a single morning dose of oral prednisolone 60 mg/m2/day for 6 weeks followed by oral prednisolone 40 mg/m2 every alternate day for the subsequent 6 weeks. The total number of relapses within six months after the initial episode was collected in a data collection sheet. Every relapse was correlated with age of onset, sex, initial serum albumin level, fasting serum cholesterol level, and time to response in the initial attack. The association between relapse and its potential risk factors was investigated using logistic regression analysis. Results: The study found that INS was significantly associated with sex and age (p< 0.05). Male children were 3.04 times (95% CI= 1.09- 8.45, P=0.03) more likely to experience relapse. Furthermore, children with respiratory tract infection had a higher chance of relapse (OR= 4.43, 95% CI= 1.26-15.53, P=0.02). Lower cholesterol levels (≤500 mg/dl) were found to be a protective factor (OR= 0.13, 95% CI= 0.04-0.54, P=0.005) in this study. The chance of relapse was higher in children who responded after 2-4 weeks of starting treatment compared to those who responded in less than one week (p<0.005).Conclusion: The study found that the first episode INS had a higher risk of relapse in boys with respiratory tract infection and in patients who needed more than two weeks of prednisolone treatment to achieve remission.Keywords: Children; Frequently Relapsing; Predictors; Idiopathic Nephrotic Syndrome.

Association of Early Nutritional Status with the Clinical Severity in Patients with Acute Stroke

Background: Prevalence of malnutrition in stroke patients in Indonesia is not known for certain because the assessment of nutritional status has not been conducted optimally in all stroke patient5s due to the existing limitations. Early nutritional status assessment is helpful in planning the provision of nutrition for acute stroke patients. Commonly used nutritional status assessment methods are anthropometry (LOLA and TST) and biochemistry (serum albumin levels). Objective: To analyze the association of early nutritional status with clinical severity in acute stroke patients. Methods: The study design was a prospective cohort with consecutive sampling according to inclusion and exclusion criteria of 102 subjects. Initial nutritional status was measured in Upper Arm Circumference (LOLA), Triceps Skinfold Thickness (TST), and serum albumin level. The clinical severity was measured by calculating the NIHSS (National Institutes of Health Stroke Scale) at admission to hospital and the 7th day of stroke. Data was analyzed using chi square (p &lt;0.05). Results: Most subjects were males (52.00%) with mean age of clinical severity was 54.48 ± 9.634 years old. There was no significant association between initial nutritional status (p = 0.227) and serum albumin level (0.552) with clinical severity. The measurements of LOLA (p = 0.049) and TST (p = 0.481) were statistically significant (p = 0.049) but not clinically. Conclusion: There was no association between early nutritional status that was measured with LOLA, TST and serum albumin levels with clinical severity measured with NIHSS scale in acute stroke patients

Serum albumin changes and mortality risk of peritoneal dialysis patients.

Initial or single time point serum albumin levels have been shown to be important in predicting the prognosis of peritoneal dialysis (PD) patients. However, we assume the dynamic change and trend of albumin after PD are essential. We aimed to investigate the association between baseline albumin levels, albumin trajectories, and patient mortality in a retrospective cohort study. In this retrospective cohort study, 547 incident PD patients were enrolled from Peking University Third Hospital. Date were collected by medical records review, including age, gender, body mass index, primary disease, comorbidities, and laboratory tests. A joint model for longitudinal data and time-to-event data was used to establish the relationship between serum albumin trajectories and mortality risk of PD patients. The albumin trajectories was negatively correlated with risk of death. The increase in the current value of albumin trajectories at time points t after PD was associated with decreased risk of death (HR = 0.881, p < 0.0001). There was no statistical association between initial albumin and risk of death (HR = 1.030, 95% CI 0. 995-1.066). The results showed that increased age, higher albumin-corrected Ca levels, and higher eGFR values were risk factors for death. In addition, predictors of low albumin levels are increased PD time, increased age, increased albumin-corrected Ca, and decreased BMI as well as initial albumin levels. This study demonstrates that albumin trajectories after PD is better than initial serum albumin level in predicting mortality risk. Increasing albumin level over time can improve the prognosis of PD patients.

Hypoalbuminemia as a relapse risk factor after high dose chemotherapy and autologous stem cell transplantation in patients with Hodgkin’s lymphoma

Assessing the risk factors according to EORTC (European Organization of Research and Treatment of Cancer) or HD IPS (Hodgkin’s lymphoma International Prognostic Score) is crucial for choosing the adequate I line therapy in Hodgkin’s lymphoma patients. However, none of those scales predicts the efficacy of autologous stem cell transplant (ASCT) in relapsing/refractory (R/R) patients. Progression- free survival (PFS) after ASCT corelates with the response to salvage regimens. Thirty-nine Hodgkin’s lymphoma patients transplanted at Jagiellonian University Department of Hematology with a follow-up exceeding 5 years were analyzed. Despite long time periods since the diagnosis, initial serum albumin levels seem to correlate with progression after autologous stem cell transplant and indicate high probability of relapse within 5 months following the procedure with favorable test characteristics.

Diagnostic Performance of Initial Serum Albumin Level for Predicting In-Hospital Mortality among Necrotizing Fasciitis Patients.

Background: Hypoalbuminemia is known to be associated with adverse outcomes in critical illness. In this study, we attempted to identify whether hypoalbuminemia on emergency department (ED) arrival is a reliable predictor for in-hospital mortality in necrotizing fasciitis (NF). patients. Method: A retrospective cohort study of hospitalized adult patients with NF was conducted in a tertiary teaching hospital in Taiwan between March 2010 and March 2018. Blood samples were collected in the ED upon arrival, and serum albumin levels were determined. We evaluated the predictive value of serum albumin level at ED presentation for in-hospital mortality. All collected data were statistically analyzed. Result: Of the 707 NF patients, 40 (5.66%) died in the hospital. The mean serum albumin level was 3.1 ± 0.9 g/dL and serum albumin levels were significantly lower in the non-survivor group than in the survivor group (2.8 ± 0.7 g/dL vs. 3.5 ± 0.8 g/dL). In the multivariable logistic regression model, albumin was significantly associated with in-hospital mortality (odds ratio (OR) 0.92, 95% confidence interval (CI) 0.88–0.96, p < 0.001). The area under-the-receiver-operating-characteristic curve (AUC) for in-hospital survival was 0.77 (95% CI 0.72–0.82) and corresponding sensitivity, specificity, positive predictive value, negative predictive value, and positive and negative likelihood ratio were 66%, 74%, 33%, 88%, 2.25, and 0.48, respectively. High sensitivity (96%) for survival was shown at albumin level of 4.0 g/dL and high specificity (91%) for mortality was shown at a level of 2.5 g/dL. Conclusion: Initial serum albumin levels strongly predicted in-hospital mortality among patients with necrotizing fasciitis. NF patients with hypoalbuminemia on ED arrival should be closely monitored for signs of deterioration and early and aggressive intervention should be considered to prevent mortality.

Serum Levels of Albumin and Prealbumin Do Not Correlate With Nutrient Delivery in Surgical Intensive Care Unit Patients.

Serum albumin and prealbumin levels, may be more strongly associated with inflammation than with nutrient delivery. Their predictive value has not been extensively described in surgical intensive care unit (ICU) patients. We analyzed a registry of adult surgical ICU patients receiving enteral nutrition. Subjects with at least 1 serum albumin, prealbumin, or C-reactive protein (CRP) level were included. Demographic, nutrition, and clinical outcome data were collected. A total 252 subjects were included. A subset had serial measurements: albumin (n = 194), prealbumin (n=13), CRP (n=9), white blood cell (WBC) (n = 131), and neutrophil-lymphocyte ratio (NLR) (n=86). Serum albumin level was inversely correlated with all 3 inflammatory biomarkers (CRP, ρ=-0.24, P<0.02; WBC, ρ=-0.15, P <0.001; and NLR, ρ=-0.26, P<0.001). Change in serum albumin level was inversely correlated with change in NLR (ρ = -0.22, P = 0.044) but not with CRP or WBC. Admission serum albumin level was significantly higher in nourished vs. moderately and/or severely malnourished patients (3.2 [2.7-3.7] vs. 2.7 [2.3-3.0], P=0.004). Admission serum prealbumin level was significantly higher in nourished vs. moderately and/or severely malnourished patients (9 [7-12] vs. 4 [3-5], P=0.001). Serum albumin level was inversely correlated with Charlson Comorbidity Index (ρ= 0.20, P=0.001). Calorie and/or protein delivery in the ICU was not correlated with changes in serum albumin or prealbumin levels. In the ICU, initial serum albumin levels and serial trends are inversely correlated with inflammation. Although initial serum albumin levels are reflective of baseline nutrition status, neither serum albumin level nor serum prealbumin level trends correlate with calorie or protein deficits and should not be used to assess adequacy of nutrition delivery.

A Case Report of Nephrotic Syndrome While Undergoing Quinine Therapy

We summarize the case of an 81-year-old Caucasian female who presented to her family physician with signs and symptoms of nephrotic syndrome following a brief exposure to quinine. Prior to that visit, she was clinically well with no chronic medical ailments and met with her family physician for annual physical assessments. She had taken 11 tablets of quinine for nocturnal leg cramps over the course of 28 days before starting to notice mild peripheral edema, which subsequently progressed, leading to a family physician review. Her initial serum albumin level was 12 g/L, and a 24-hour urine protein output was quantified at 8.14 g/day; she was diagnosed as having nephrotic syndrome. A kidney biopsy confirmed the diagnosis of minimal change disease (MCD). Quinine therapy was stopped, and she was initiated on a tapering regime of prednisone with concurrent cyclosporine therapy. Within a fortnight of starting therapy, she went into remission and her immunosuppressive medications were rapidly tapered and discontinued. This paper reports an association between the use of quinine and subsequent MCD. This case report proposes that the use of quinine has an association with, and may be causal for, the development of minimal change disease. As this is yet an unreported adverse effect, this paper seeks to increase the knowledge of the varied and numerous effects of quinine.

Predicting mortality in extremely low birth weight infants: Comparison between gestational age, birth weight, Apgar score, CRIB II score, initial and lowest serum albumin levels.

We explored GA, BW, Apgar score, CRIB II score, and serum albumin levels as univariate predictors of mortality in extremely low birth weight infants. Medical records of 564 extremely low birth weight infants were reviewed retrospectively. The infants were grouped as survivors (group I), expired ≤ 7th postnatal day (group II), and expired > 7th postnatal day (group III). The predictive value for mortality of gestational age, birth weight, Apgar scores at 1 and 5 min, clinical risk index for babies II score, and first and lowest serum albumin levels was assessed by calculating the associated area under the curve (AUC) in receiver operating characteristic (ROC) curves. The overall survival and mortality rates of groups I, II, and III were 81.0% (457/564), 7.6% (43/564), and 11.4% (64/564), respectively. Birth weight, Apgar scores at 1 and 5 min, and first serum albumin levels were significantly higher, while the clinical risk index for babies II score was significantly lower in group I when compared to groups II and III. Gestational age and lowest serum albumin level in group I were significantly higher than group III, but not group II. However, gestational age, birth weight, and clinical risk index for babies II score showed gestational age dependent variations regardless of survival or mortality. Apgar score at 5 min (0.756) and lowest serum albumin level (0.771) demonstrated the highest AUC of the ROC curve in predicting mortality in group II and III, respectively. In conclusion, Apgar score at 5 min and lowest serum albumin level were the most effective predictors for mortality in extremely low birth weight infants during ≤ 7th and > 7th postnatal days, respectively.

488 - Tacrolimus Levels and Correlation to Age and Weight Calculation

Background: Tacrolimus (FK) has become one of the key calcineurin inhibitors routinely used to reduce the risk of graft-versus-host-disease in patients undergoing allogeneic stem cell transplant (SCT). As non-ablative regimens have increased the number of transplants in the geriatric population, the data from initial studies may not accurately reflect our current transplant patients. Although the mechanism of action in elderly patients is similar, the metabolism and tolerability may be different. The narrow therapeutic index, drug interactions, and metabolism via the CYP450 pathway present unique challenges to achieving therapeutic drug levels. Current dosing at our institution relies exclusively on actual body weight (ABW) without taking into account age, gender, serum albumin, and ideal body weight (IBW). With this retrospective study, we explore the impact these factors may have on tacrolimus serum concentrations and associated toxicities. Methods: We performed a chart review of patients over the age of 18 who received tacrolimus as part of their allogeneic SCT at our center between 2014 and 2017. The following variables were obtained from the medical records: age, gender, ABW, height, IBW, initial FK dose, serum albumin, and FK trough levels within the first 2 weeks. Patients who did not have FK levels drawn within 5 days of starting treatment, those who received concomitant CYP inhibitors without dose adjustment, and those who died within 30 days from SCT were excluded. Results: Ninety-five patients met the criteria of which 59 were males and 36 females. Forty-six patients were supratherapeutic at first trough and 76 were supratherapeutic at either the first, second, or third level. Of the patients with supratherapeutic levels, 34.2% had clinical toxicity (n = 26). Male patients (P = .0006) and patients over age 65 (P = .0399) were more likely to be supratherapeutic at first tacrolimus trough. After adjusting for age and gender, the odds of having a supratherapeutic FK trough were 3.1 times higher for every .5 mg increase with ABW dosing (when using IBW as baseline). Conclusions: The current patient population undergoing allogeneic SCT requires a revised strategy for optimal care. The data presented here suggests male gender and age over 65 are predictive of having a supratherapeutic first FK trough which may favor the use of a lower starting dose. Similarly, the higher supratherapeutic events in patients with a greater difference between ideal and actual weights hints at improved dosing when the IBW is used in overweight patients. Our study suggests that age, gender, and IBW should be factored into tacrolimus dosing to prevent overtreatment and toxicities. Further prospective studies are needed to confirm these observations.

The Unexpected Effects of L-Carnitine Supplementation on Lipid Metabolism in Hemodialysis Patients

Background/Aims: There is a growing body of evidence that the long-term hemodialysis (HD) treatment leads to disturbances of carnitine homeostasis but the results of L-carnitine supplementation in HD patients have been conflicting. In the present prospective study, we investigated the effectiveness of intravenous L-carnitine in mitigating dialysis-related protein-energy wasting (PEW) based on pre-treatment albumin levels. Methods: Fifty patients (46% male, mean age 63±18.28 years, HD vintage 37.5 (7-288) months) received 1 g L-carnitine intravenously at the end of every HD session for 12 months. Clinical data were obtained from the medical records and charts. Intradialytic hypotension periods (defined as a decrease of systolic blood pressure by ≥ 20 mmHg) were recorded. Dietary habits were evaluated using a self-administered questionnaire prior to L-carnitine supplementation. Laboratory parameters were measured prior to the supplementation and controlled in 6-months intervals. Anthropometric measurements were performed prior to HD session, including „dry“ body weight and height, body mass index (BMI), and body composition analysis using bioimpedance spectroscopy. Malnutrition-inflammation score (MIS) was used as a scoring system representing the severity of PEW and an indicator of general functional capacity. Results: A significant increase in total cholesterol, predominantly on the account of LDL was found (p=0.005). Simultaneously, HDL decreased (p=0.001) while triglyceride levels remained unchanged. Although the rise in serum prealbumin could be observed, lean tissue index (LTI) decreased and fat tissue index (FTI) increased which resulted in reduction of the LTI/FTI ratio (p=0.002). When divided into two groups according to the pre-treatment albumin values (< 35 g/L or ≥35 g/L), patients from the higher albumin group showed significant increase in prealbumin (p=0.005), and improved MIS (p=0.03). Multivariate regression analysis showed that higher FTI after introduction of L-carnitine led to greater hemodynamic stability (OR 1.709, 95% CI 1.006-2.905, p=0.048). As there was no differences in HD treatment characteristics, primery kidney disease or residual diuresis we could conclude that positive energy balance (with an increase in prealbumin and FTI) eventually led to better hemodynamic stability. Conclusion: Our results show significant effects of L-carnitine supplementation on lipid metabolism. Further clinical trials, as well as experimental research are needed to define the role of lipid metabolism in CKD population. Significant benefits of L-carnitine supplementation in patients with better initial serum albumin levels suggest that this therapy should not be restricted to patients with the worst nutritional and overall status.

Diagnostic performance of initial serum albumin level for predicting in-hospital mortality among aspiration pneumonia patients

PurposeThe predictive value of serum albumin in adult aspiration pneumonia patients remains unknown. MethodsUsing data collected during a 3-year retrospective cohort of hospitalized adult patients with aspiration pneumonia, we evaluated the predictive value of serum albumin level at ED presentation for in-hospital mortality. Results248 Patients were enrolled; of these, 51 cases died (20.6%). The mean serum albumin level was 3.4±0.7g/dL and serum albumin levels were significantly lower in the non-survivor group than in the survivor group (3.0±0.6g/dL vs. 3.5±0.6g/dL). In the multivariable logistic regression model, albumin was associated with in-hospital mortality significantly (adjusted odds ratio 0.30, 95% confidential interval (CI) 0.16–0.57). The area under the receiver operating characteristics (AUROC) for in-hospital survival was 0.72 (95% CI 0.64–0.80). The Youden index was 3.2g/dL and corresponding sensitivity, specificity, positive predictive value, negative predictive value, positive and negative likelihood ratio were 68.6%, 66.5%, 34.7%, 89.1%, 2.05 and 0.47, respectively. High sensitivity (98.0%) was shown at albumin level of 4.0g/dL and high specificity (94.9%) was shown at level of 2.5g/dL. ConclusionInitial serum albumin levels were independently associated with in-hospital mortality among adult patients hospitalized with aspiration pneumonia and demonstrated fair discriminative performance in the prediction of in-hospital mortality.

Evaluation of clinical prognostic factors for interstitial pneumonia in anti-MDA5 antibody-positive dermatomyositis patients

Objectives: We retrospectively investigated clinical prognostic factors for interstitial pneumonia (IP) in anti-melanoma differentiation-associated gene 5 (MDA5) antibody (Ab)-positive dermatomyositis (DM) patients.Methods: Subjects comprised 18 patients with anti-MDA5 Ab-positive DM-IP (9 survivors; 9 deaths).Results: Initial serum albumin levels, ferritin levels, and ground-glass opacity (GGO) scores in the right middle lobes were significantly higher in the death group than in the survivor group (p = .033, .013, and .005, respectively). Initial alveolar-arterial oxygen gradient (P[A-a]O2) was also higher in the death group than in the survivor group (p = .064). Initial serum ferritin, P[A-a]O2, and right middle lobe GGO score were found to significantly relate to death. Survival rates after 24 weeks were significantly lower among patients with an initial ferritin level of ≥450 ng/mL (25%), P[A-a]O2 of ≥30 mmHg (31%), and a right middle lobe GGO score of ≥2 (11%) than each of the others (p = .006, .020, and .002, respectively).Conclusions: An initial serum ferritin level of ≥450 ng/mL, P[A-a]O2 of ≥30 mmHg, and right middle lobe GGO score of ≥2 (GGO ≥5% of the lobe) were identified as poor prognostic factors for anti-MDA5 Ab-positive DM-IP patients.

Trajectories of Serum Albumin Predict Survival of Peritoneal Dialysis Patients: A 15-year Follow-Up Study.

Although initial serum albumin level is highly associated with overall and cardiovascular mortality in peritoneal dialysis (PD) patients, we consider that the dynamic change and trend of albumin after initiation of PD are also essential.We enrolled patients who received PD for more than 3 months from January 1999 to March 2014. We categorized these patients into 2 groups by the difference in serum albumin level (Δalbumin = difference between peak with initial albumin level = peak albumin level − initial albumin level) after PD. The patients with Δalbumin < 0.2 g/dL (median level) were considered as group A (n, number = 238) and those with Δalbumin ≥ 0.2 g/dL were considered as group B (n = 278). Further, we stratified these patients into quartiles: Q1 Δalbumin < −0.2 g/dL; Q2, −0.2 ≦∼ <0.2 g/dL; Q3, 0.2 ≦∼ <0.6 g/dL; and Q4, ≥0.6 g/dL. Regression analysis was performed to determine the correlation of initial albumin and Δalbumin.Group A patients presented with higher levels of serum albumin (3.71 ± 0.54 vs 3.04 ± 0.55 g/dL; P < 0.001) and hematocrit as well as better initial residual renal function. However, those in group A had lower serum albumin increment and downward-sloped trends after dialysis. In contrast, the albumin trend was upward sloped and the increment of albumin was remarkable in group B, despite the high prevalence of cardiovascular diseases and diabetes. Overtime, group A patients had poorer survival and experienced more frequent and longer hospitalizations. Group Q1 patients with least albumin increment had worst survival. Group Q4 patients with lowest initial albumin also had poor survival. Age, diabetes, cardiovascular diseases, BMI, initial albumin, and Δalbumin could affect patient outcomes independently. Regression analysis showed a better outcome can be obtained if the initial albumin level is at least above 3.15 g/dL. (Initial albumin level = −0.61 × Δalbumin + 3.50.)The increment and trend of albumin especially during early period of PD may be a more crucial determinant for survival.

Increasing high-sensitive C-reactive protein level predicts peritonitis risk in chronic peritoneal dialysis patients

BackgroundThe aim of this study was to evaluate whether a high baseline level of high-sensitivity C-reactive protein (hs-CRP) or changes in the level predicts the risk of peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD).MethodsA prospective, cross-sectional, case–control study was conducted in a single hospital-based PD unit. A total of 327 patients were included in the study. Serum hs-CRP was measured annually for 2 years. Patients were divided into 4 groups according to the changes in annual hs-CRP levels (at baseline and at 1 year intervals): group 1 (from <5 mg/L to <5 mg/L, n = 171), group 2 (from <5 mg/L to ≥5 mg/L, n = 45), group 3 (from ≥5 mg/L to <5 mg/L, n = 45), and group 4 (from ≥5 mg/L to ≥5 mg/L, n = 80). Demographics, biochemistry results, PD adequacy indices, and peritonitis risk were compared between the groups.ResultsThe initial serum albumin level was similar in the 4 groups (p = 0.12). There was a negative linear correlation between the serial albumin change (∆alb) and serial hs-CRP change (∆hs-CRP; r = −0.154, p = 0.005). The hazard ratio (HR) for peritonitis was significantly higher in group 2 (HR = 1, reference) than in group 4 (HR = 0.401, 95% CI 0.209 − 0.769). Group 2 had a greater serum albumin decline rate (∆alb: –3% ± 9%) and hs-CRP elevation rate (∆hs-CRP: 835% ± 1232%) compared to those for the other groups.ConclusionsA progressive increase in the hs-CRP level was associated with a corresponding decline in the serum albumin level. Progressive rather than persistently high levels of serum hs-CRP predicted peritonitis risk in CAPD patients.

A Modified Glasgow Prognostic Score (mGPS) Based On Systemic Inflammatory Response Is a Useful Indicator to Predict Response and Survival in Patients with Newly Diagnosed Diffuse Large B-Cell Lymphoma (DLBCL)

AbstractAbstract 5089Systemic inflammatory responses as evidenced by CRP and albumin have reported as a useful indicator of prognosis in patients with advanced cancers. We retrospectively evaluated the relationship between the systemic inflammation score and survival in 213 patients with DLBCL receiving the first-line R-CHOP chemotherapy between October 2003 and December 2011 at Chonnam National University Hwasun Hospital. Patients were assorted into three groups based on initial serum CRP, albumin and LDH level at diagnosis, as named by ¡°modified Glasgow prognostic score (mGPS)¡±. Patients with elevated CRP (> 1. 0 mg/dL), hypoalbuminemia (< 3. 5 g/dL) and elevated LDH (> 1¢¥ upper normal value) were assigned a score of 2. Patients in whom one or two of these biochemical abnormalities was present were assigned of 1. Patients in whom neither of these abnormalities was present were assigned a score of 0. In Cox multivariate analysis, the independent poor prognostic factors for progression free survival (PFS) were mGPS 2 (HR 5. 415, 95% CI 2. 028–14. 454, P = 0. 001), ECOG PS ¡Ã 2 (HR 3. 504, 95% CI 1. 655–7. 419, P = 0. 001), and bulky lesion ¡Ã 10cm (HR 2. 030, 95% CI 1. 037–3. 972, P = 0. 039). In addition, the independent poor prognostic factors for overall survival (OS) were mGPS 2 (HR 5. 898, 95% CI 2. 028–14. 454, P = 0. 001) and ECOG PS ¡Ã 2 (HR 3. 525, 95% CI 1. 642–7. 567, P = 0. 001). The overall response rate, including complete response and partial response, for the R-CHOP chemotherapy was decreased according to the mGPS; 96. 7% at mGPS 0, 87% at mGPS 1, and 75% at mGPS 2 (P = 0. 009). This study suggest that the modified Glasgow prognostic score (mGPS) based on systemic inflammatory responses (CRP, albumin and LDH) was a useful prognostic indicator for OS and PFS and also a reliable method to predict the response for R-CHOP chemotherapy in patients with newly diagnosed DLBCL. [Display omitted] Disclosures:No relevant conflicts of interest to declare.

Effects of AA Amyloidosis on Survival in Peritoneal Dialysis

Background: To investigate the effects of ESRD etiologies on mortality in peritoneal dialysis patients. Methods: We included patients who initiated therapy between 2001-2011 and classified them according to etiologies including amyloidosis, diabetes mellitus, chronic glomerulonephritis and polycistic renal disease. Socio-demographic data, clinical courses and infectious complications were compared between groups, and the reasons for peritoneal dialysis withdrawal were recorded. Patient and technique survival analysis were performed. Results: 354 patients were included to the study. Thereafter, 154 patients were excluded. Totally, 29 patients with AA-amyloidosis (mean age 37.9±16.4 years, follow-up time 21.7±20.2 months), 78 patients with diabetes mellitus (mean age 56.9±13.6 years, follow-up time 35±28.6 months), 68 patients with chronic glomerulonephritis (mean age 37.2±12 years, follow-up time 47.7±29.9 months), 29 patients with polycystic renal disease (mean age 35.6±13.8 years, follow-up time 45.4±36.8 months) were evaluated. Albumin level was lower in patients with amyloidosis at initiation and the end of study (for both p<0.001). Incidence of peritonitis and catheter exit site/tunnel infection attacks were higher in patients with amyloidosis (p=0.002 and 0.018 respectively). There was statistical difference among groups with respect to the last status of patients (p<0.001). Deaths were frequent in amyloidotic and diabetic patients. The majority of deaths were due to peritonitis and/or sepsis and, cardiovascular reasons. The mortality rate was found higher in patients with amyloidosis (log rank=0.005), especially at first 2-3 years. Presence of anyone helping to administer peritoneal dialysis(OR:6.244, p=0,025), initial serum albumin level(OR:0.352, p=0,034) and presence of catheter exit site/tunnel infection(OR:0.250, p=0,015) were independent predictors of patient survival. Conclusion: Renal failure etiology has effects on peritoneal dialysis patients’ survival. Patients with amyloidosis have the worst survival. Because of loss of PD survival advantage seen in first years of therapy in patients with amyloidosis, peritoneal dialysis may not be suitable as first choice therapy in this group.