Low Albumin Group Research Articles

Association of low serum albumin concentration and adverse cardiovascular events in stable coronary heart disease

ObjectiveCoronary heart disease (CHD) is a leading cause of death in developed countries. Exploration of indicators to identify high risk individuals who develop adverse outcomes despite stable baseline condition is important. This study is to evaluate the association between serum albumin concentration and cardiovascular (CV) outcomes in individuals of stable CHD. MethodsSeven-hundred–thirty-four participants from Biosignature study, a nationwide prospective cohort study aimed to identity risk factors among patients with stable CHD, were enrolled for analysis. They were divided into low serum albumin group (baseline albumin concentration <3.5g/dL, n=98) and normal albumin group (baseline albumin concentration ≥3.5g/dL, n=636). The relations between baseline albumin and adverse CV outcomes within 18months of follow-up were analyzed. ResultsCompared baseline characteristics with normal albumin group, subjects in low albumin group are older, having more diabetic patients, lower hemoglobin level, lower estimated glomerular filtration rate, lower total cholesterol level, lower left ventricular ejection fraction, and higher blood glucose. While there is no significant difference of total CV events between two groups, low serum albumin concentration is associated with an increased risk of all-cause mortality (10.2% vs. 0.5%, p<0.001) and hard CV events (7.1% vs. 1.4%, p<0.001). The association remains significant after adjustments for confounders (all-cause mortality, HR: 6.81, 95% CI: 1.01–45.62; hard CV events, HR: 3.68, 95% CI: 1.03–13.19). ConclusionsLow serum albumin concentration (<3.5g/dL) worsens prognosis of patients with stable CHD.

Albumin correlates with all-cause mortality in elderly patients undergoing transcatheter aortic valve implantation.

Albumin is a marker of frailty. Scarce data are available on correlations between frailty-related parameters and outcomes in patients undergoing TAVI. This study sought to evaluate the relation between albumin and mortality in TAVI candidates. A total of 150 patients (mean age 81±6 years) undergoing TAVI were included in the study. Patients with pre-procedural albumin >4 g/dl (>40 g/L) (n=71) were compared to those ≤4 g/dl (≤40 g/L) (n=79). The cut-off value of 4 g/dl (40 g/L) was based on the mean value of albumin in the patients included in the study. During a mean follow-up of 2.1 years the survival rate was 72%. Patients in both groups had similar baseline characteristics. The 2.1-year mortality was higher in the low albumin group compared with the normal albumin group (35% vs. 19%, p=0.01). Multivariate analysis indicated that low pre-procedural albumin was independently associated with a more than twofold increase in 2.1-year all-cause mortality (p=0.01, HR=2.28; 95% CI: 1.17-4.44). Low post-procedural serum albumin remained a strong parameter correlated with all-cause mortality (HR=2.47; 95% CI: 1.28-4.78; p<0.01). Baseline albumin can be used as a simple tool that correlates with survival after TAVI. Low albumin is an important parameter associated with all-cause mortality after the procedure.

Low Albumin Is a Risk Factor for Complications after Revision Total Knee Arthroplasty.

Low serum albumin has been shown in the primary joint arthroplasty setting to increase the rate of perioperative complications. Our present work examined a large national inpatient administrative dataset to study the relationship between serum albumin level and key outcome measures after revision total knee arthroplasty (RTKA). Our hypothesis was that lower serum albumin would be an independent risk factor for poor outcomes after RTKA. We analyzed the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2006 to 2014, specifically evaluating patients undergoing RTKA. Patients were grouped as having hypoalbuminemia (serum albumin < 3.5 mg/dL) or normal albumin (serum albumin ≥ 3.5). We analyzed data on 22 complications as reported in the NSQIP database and developed composite complication variables (any infections, cardiac/pulmonary complications, and any major complications). For each complication, multivariable logistic regression analysis was used to evaluate its association. The cohort included 4,551 patients undergoing RTKA. Patients in the low serum albumin group were statistically more likely to develop deep surgical site infection, organ space surgical site infection, pneumonia, urinary traction infection, and sepsis. The hypoalbuminemic group was more likely to require unplanned intubation, blood transfusion intraoperatively or postoperatively, remain on a ventilator > 48 hours, and develop acute renal failure. There was also a higher risk of mortality and coma. Across the three composite complication variables, any complication (with or without transfusion), any major complication, and any infection (systemic, wound) were more prevalent among the patients with low serum albumin. This study confirms the relationship between suboptimal nutritional status and complications following RTKA. Hypoalbuminemia may be used as a potential preoperative predictor of outcomes. Understanding the effects of malnutrition on perioperative complications informs the choice of appropriate candidates for surgical intervention, timing of surgery, resource allocation, and risk counseling preoperatively.

Relationship Between Serum Albumin Levels and Infections in Newborn Late Preterm Infants.

BackgroundWe aimed to evaluate the clinical value of serum albumin levels for the evaluation and prognosis of late preterm infants with infections.Material/MethodsThis was a retrospective study performed in late preterm infants admitted at the neonatal intensive care unit (NICU) of the Liaocheng People’s Hospital between July 2012 and March 2013. Data, including laboratory test results, neonatal critical illness score (NCIS), perinatal complications and prognosis, were analyzed. The newborn infants were divided into 3 groups according to their serum albumin levels, (≥30 g/L, 25–30 g/L and ≤25 g/L for high, moderate, and low, respectively).ResultsAmong 257 patients, birth weight was 2003±348 g, gestational age was 35.7±2.3 weeks, and 59.1% were male. In addition, 127 (49.4%) were in the low albumin group. There were 32 patients with sepsis, 190 with infections, and 35 without infection, and their rates of hypoalbuminemia were 86.0%, 50.5%, and 30.7%, respectively (P<0.05). Albumin levels of the patients who survived were higher than those of the patients who died. In the low albumin group, the number of individual-event-critical NCIS cases and the frequency of multiple organs injuries were 63.8% and 28.3%, respectively, and were higher than in the 2 other groups. Mortality was higher in patients with sepsis. Hypoalbuminemia was associated with severe adverse outcomes (odds ratio=6.3, 95% confidence interval: 3.7–10.9, P<0.001).ConclusionsHypoalbuminemia was frequent among neonates with sepsis. Lower albumin levels might be associated with a poorer prognosis. Albumin levels could be appropriate for the diagnosis and prognosis of late preterm neonates with infections.

Effect of Preoperative Albumin Levels on Outcomes in Patients Undergoing Left Ventricular Device Implantation.

Hypoalbuminemia is a well-known predictor of morbidity and mortality in cardiac surgery. Our aim was to establish the impact of serum albumin on outcomes after left ventricular assist device (LVAD) implantation. This was a single-institution retrospective review, including all patients who underwent LVAD implantation between March 2006 and June 2014. Two hundred patients were included in the analysis. Mean serum albumin was 3.27 ± 0.47 g/dl, with 7% in the low albumin group (<2.5 mg/dl), 67.5% in the mid-range (2.5-3.5 mg/dl), and 25.5% in the normal albumin groups (> 3.5 mg/dl). Lower albumin was associated with a significant increase in postoperative renal failure (42.9 vs. 16.5 vs. 17.3%; p = 0.05) and prolonged hospitalization (median 28.5 vs. 16 vs. 15.5 days; p = 0.008). Six month, 1 year, and 5 year survival was 79%, 79%, and 49% with low, 84%, 78%, and 51% with mid-range, and 94%, 88%, and 60% with normal albumin, respectively (p = 0.22). Preoperative hypoalbuminemia is associated with postoperative acute renal failure (ARF) and prolonged hospitalization after LVAD implantation, with no effect on overall survival. Hypoalbuminemia is most likely a marker of advanced disease and should not, in itself, be considered a contraindication to LVAD candidacy.

Low Albumin Levels, More Than Morbid Obesity, Are Associated With Complications After TKA.

Background Morbid obesity and malnutrition are thought to be associated with more frequent perioperative complications after TKA. However, morbid obesity and malnutrition often are co-occurring conditions. Therefore it is important to understand whether morbid obesity, malnutrition, or both are independently associated with more frequent perioperative complications. In addition, assessing the magnitude of an increase in complications and whether these complications are major or minor is important for both conditions.

Total 25(OH) vitamin D, free 25(OH) vitamin D and markers of bone turnover in cirrhotics with and without synthetic dysfunction

Current clinical assays for total 25-hydroxy (OH) vitamin D measure vitamin D bound to vitamin D-binding protein (DBP) and albumin plus unbound ('free') D. We investigated the relationship between total and free 25(OH)D with bone metabolism markers in normal (>3.5 g/dl) vs. low (≤3.5 g/dl) albumin cirrhotics. Eighty-two cirrhotics underwent measurement of free and total 25(OH)D by immunoassay, DBP and markers of bone metabolism [intact parathyroid hormone (iPTH), C-telopeptide (CTX), bone-specific alkaline phosphatase (BSAP), osteocalcin, amino-terminal pro-peptide of type 1-collagen (P1NP)]. Pearson's coefficients assessed relevant associations. Cirrhotics with low (n = 54) vs. normal (n = 28) albumin had lower total 25(OH)D (12.1 vs. 21.7 ng/ml), free 25(OH)D (6.2vs.8.6 pg/ml) and DBP(91.4 vs. 140.3 μg/ml) [P < 0.01 for each]. iPTH was similar in low and normal albumin groups (33 vs. 28 pg/ml; P = 0.38), although serum CTX(0.46vs.0.28 ng/ml) and BSAP(31.7 vs. 24.8 μg/L) were increased (P < 0.01). An inverse relationship was observed between total 25(OH)D and iPTH in normal (r = -0.47, P = 0.01) but not low albumin cirrhotics (r = 0.07, P = 0.62). Similar associations were seen between free 25(OH)D and iPTH(Normal: r = -0.46, P = 0.01; Low: r = -0.03, P = 0.84). BSAP, osteocalcin and P1NP were elevated above the normal range in all cirrhotics but not consistently associated with total or free 25(OH)D. Cirrhotics with low vs. normal albumin have lower levels of DBP, total and free 25(OH)D. The expected relationship between total or free 25(OH)D with iPTH was observed in normal but not in low albumin cirrhotics, demonstrating that total 25(OH)D is not an accurate marker of bioactive vitamin D status in cirrhotics with synthetic dysfunction. Additional investigation into the role of vitamin D supplementation and its impact on bone mineral homoeostasis in this population is needed.

Impact of Pre-Procedural Serum Albumin Levels on Outcome of Patients Undergoing Transcatheter Aortic Valve Replacement

Risk assessment for transcatheter aortic valve replacement (TAVR) patients is challenging, and surgical scores do not optimally correlate with outcome. The aim of this study was to assess the correlation between serum albumin and survival of patients with symptomatic severe aortic stenosis undergoing TAVR. Patients with severe aortic stenosis who underwent TAVR were categorized into 2 groups according to low and normal preprocedural serum albumin (<3.5 and ≥3.5 g/dl, respectively). The all-cause mortality rates at hospital discharge, at 30-day and 1-year follow-up were compared across the groups. Additionally, a Cox proportional-hazards model was generated to assess the independent effect of serum albumin at 1-year follow-up. Among 567 consecutive patients who underwent TAVR, 476 (84%) had documented preprocedural serum albumin measurements. Of these, 50% had low serum albumin levels, and 50% had normal serum albumin levels. Baseline and procedural characteristics, including age, gender, and transapical access, were similar among the groups. Prevalence of left ventricular ejection fraction<40% was higher in patients with low albumin (29% vs 20%, p=0.02), and risk assessment according to Society of Thoracic Surgeons score tended to be higher in the low-albumin group (10±4.7 vs 9.4±4.4, p=0.09). Patients presenting with low albumin had higher in-hospital mortality (11% vs 5%), as well as at 30-day (12% vs 6%, p=0.01) and 1-year (29% vs 19%, p=0.02) follow-up. Serum albumin was independently associated with 1-year mortality (adjusted hazard ratio per 0.1 g/dl decrease 1.64, 95% confidence interval 2.50 to 1.75, p=0.02), along with body mass index<20 kg/m2 (hazard ratio 1.89, 95% confidence interval 3.33 to 1.75, p=0.03). In conclusion, preprocedural serum albumin level and low body mass index are independently associated with mortality in patients who undergo TAVR. Patients with severe aortic stenosis and low albumin levels should undergo careful evaluation before and after TAVR.

Serum Albumin Level < 32 g/l on Day 30 Can Predicts Higher Risk of Non-Relapse Mortality in Acute Lymphoblastic Leukemia Following Allogeneic Stem Cell Transplantation

Introduction: It is extremely significant issue to predict hematopoietic stem cell transplant (HSCT) outcomes using a biomarker. In this study, we attempted to evaluate the impact of post-transplant serum albumin on outcomes in patients with acute lymphoblastic leukemia (ALL). Methods: 123 patients with ALL receiving HSCTs between 1999 and 2012 at our center were evaluated for post-transplant serum albumin levels and their correlation with transplant's outcome. The level of serum albumin was retrospectively retrieved in certain time point ± 3 days for following periods: 1 month pre HSCT and then weekly after transplantation for first 3 months. 100 patients had available serum albumin levels. The ROC analyses were used to determine the most statistically significant cutoff level of serum albumin level correlating with NRM at 1 year. The ROC analysis suggested the level of 32 g/l at 4 weeks post HSCT as the best cutoff level for further analysis. Thus patients were stratified into low versus high albumin level group according to that cutoff level. Results: Median age for all patients is 37 (range 17-61), 35% were female and related donors were 57%. Matched donors were 83%. 71% were in 1st complete remission. 37% were Philadelphia chromosome positive. GVHD prophylaxis was CSA/MTX 60%, CSA/MMF 22%. Conditioning regimen was myeloablative in 95%. 61% received peripheral blood stem cells. With a median follow-up among survivors of 60 months (range 21-100), 61% patients showed albumin level ³ 32g/l at day 30 while 39% showed dropped albumin level &lt;32 g/l at day 30. The OS rate at 2 years was 61% in high albumin group versus 23% in low albumin group (p &lt; 0.001). The NRM rate was 62% in high albumin group versus 17% in low albumin group (p &lt; 0.001). However, no difference of relapse incidence was noted between the two groups. The cumulative incidence of overall acute GVHD, grades 2/4, grades 3/4 at day 120 and overall chronic GVHD at 2 years was 67%, 59%, 16% and 45% in high albumin group versus 72%, 70%, 49% and 39% in low albumin group, suggesting higher incidence of grade 3/4 acute GVHD in low albumin group vs high. In multivariate analysis, serum albumin level &lt; 32 g/l at 4 weeks was confirmed as an independent adverse risk factor for NRM (p=0.04, HR 2.81) together with acute GVHD grades 3/4 (p 0.01, HR 3.79) and chronic GVHD (p²0.001, HR 0.21). For OS, albumin level was not confirmed as an independent risk factor, but acute GVHD grade 3/4 (p&lt; 0.001, HR 3.36) and chronic GVHD (p &lt;0.001, HR 0.008) were found to be independent factors. For relapse chronic GVHD grade 3-4 was the only independent prognostic factor (p &lt;0.001, HR 0.27). Conclusion: The present study suggested that 1) serum albumin level less than 32 g/l at day 30 can predicts higher risk of non-relapse mortality and 2) dropped serum albumin might be affected by in part the occurrence of severe acute GVHD, and by independent mechanism of gut GVHD. Further study is strongly warranted to confirm the prognostic role of serum albumin level on transplant outcomes in a prospectively designed study. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Serum procalcitonin level and SOFA score at discharge from the intensive care unit predict post-intensive care unit mortality: a prospective study.

PurposeThe final decision for discharge from the intensive care unit (ICU) is uncertain because it is made according to various patient parameters; however, it should be made on an objective evaluation. Previous reports have been inconsistent and unreliable in predicting post-ICU mortality. To identify predictive factors associated with post-ICU mortality, we analyzed physiological and laboratory data at ICU discharge.MethodsPatients admitted to our ICU between September 2012 and August 2013 and staying for critical care>2 days were included. Sequential Organ Failure Assessment (SOFA) score; systemic inflammatory response syndrome score; white blood cell count; and serum C reactive protein, procalcitonin (PCT), interleukin-6 (IL-6), lactate, albumin, and hemoglobin levels were recorded. The primary end point was 90-day mortality after ICU discharge. Two hundred eighteen patients were enrolled (195 survivors, 23 non-survivors).ResultsNon-survivors presented a higher SOFA score and serum PCT, and IL-6 levels, as well as lower serum albumin and hemoglobin levels. Serum PCT, albumin, and SOFA score were associated with 90-day mortality in multiple logistic regression analysis. Hosmer-Lemeshow test showed chi-square value of 6.96, and P value of 0.54. The area under the curve (95% confidence interval) was 0.830 (0.771–0.890) for PCT, 0.688 (0.566–0.810) for albumin, 0.861 (0.796–0.927) for SOFA score, and increased to 0.913 (0.858–0.969) when these were combined. Serum PCT level at 0.57 ng/mL, serum albumin at 2.5 g/dL and SOFA score at 5.5 predict 90-day mortality, and high PCT, low albumin and high SOFA groups had significantly higher mortality. Serum PCT and SOFA score were significantly associated with survival days after ICU discharge in Cox regression analysis.ConclusionsSerum PCT level and SOFA score at ICU discharge predict post-ICU mortality and survival days after ICU discharge. The combination of these two and albumin level might enable accurate prediction.

(564) - Effect of Pre-operative Albumin Level on Patient Outcomes after Implantation of Continuous Flow Left Ventricular Assist Device

Low pre-operative serum albumin levels have been shown to portend worse outcomes in surgical patients. Recent clinical data suggest that heart failure patients with low serum albumin levels undergoing heart transplantation or implantation of a left ventricular assist device (LVAD) have decreased survival. Ninety one patients implanted with a continuous flow LVAD since 2011 were stratified into two groups based on pre-operative albumin <3.0 mg/dL (low; n=29) or ≥3 (normal; n=62). Peri-operative clinical parameters were derived from the STS database. Follow-up survival was assessed using the Social Security Death Index. Pre-operative data are shown in the Table. Operative mortality was higher in the low group (21% vs 3%; p=0.01) as was renal failure (41% vs 23%; p=0.02), length of ICU stay (430±546 vs 232±285 hrs; p=0.03), and need for skilled nursing discharge (43% vs 13%; p=0.005). Three, six and 12 month survival was 93%, 90%, and 87% and 75%, 72% and 72% in the normal and low albumin groups, respectively (p=0.02, Figure 1). In patients undergoing implantation of a continuous flow LVAD, pre-operative serum albumin level of less than 3.0 mg/dL is associated with higher perioperative mortality and renal failure, decreased 12 month survival, and increased need for discharge to a skilled nursing facility. Pre-operative optimization of physiologic factors which influence albumin levels may improve clinical outcomes and survival in continuous flow LVAD patients.Table 1Albumin<3Albumin≥3p-valueAlbumin2.7±0.13.3±0.20.007INTERMACS2.7±1.32.6±1.4NSBMI29±229±5NSCreatinine1.3±0.51.3±0.4NSAge62±1158±14NSMale76%(22/29)82%(51/62)NSCOPD55%(16/29)52%(32/62)NSDiabetes41%(12/29)40%(25/62)NSHTN86%(25/29)79%(49/62)NSCerebrovascular28%(8/29)13%(8/63)NS Open table in a new tab

Serum Concentration of Fentanyl During Conversion From Intravenous to Transdermal Administration to Patients With Chronic Cancer Pain

To the best of our knowledge, there have been no reports on the pharmacokinetics and pharmacodynamics during the conversion from continuous intravenous infusion (CII) to transdermal fentanyl administration. The primary objective of the present study was to clarify the pharmacokinetic characteristics during this conversion. A secondary objective was to identify an association between serum albumin and the absorption of fentanyl from the transdermal patch. A prospective study was conducted from February 2010 to August 2011 that enrolled 19 patients with chronic cancer pain. Patients were classified into 2 study groups according to body mass index and albumin level. All patients received the conversion from CII to transdermal fentanyl using a 2-step taper of CII over 6 hours. Comparisons of efficacy, toxicity, and serum fentanyl concentrations between study groups were analyzed at baseline, 3, 6, 9, 12, 15, 18, and 24 hours after initiation of the conversion. The dose-adjusted serum fentanyl concentrations for all patients were significantly decreased at 15 to 24 hours after conversion compared with baseline, although pain intensity and the number of rescue events remained stable during the conversion. The dose-adjusted serum fentanyl concentrations at 9 to 24 hours were significantly reduced in the low albumin group compared with the normal albumin group (P<0.05). Our study demonstrated that the dose-adjusted serum fentanyl concentrations remained relatively stable, and pain intensity and the number of rescue events remained stable during conversion. Hypoalbuminemia was strongly associated with poor absorption of transdermally administered fentanyl.

Relationship between admission albumin levels and rehabilitation outcomes in older patients

The relationship between serum albumin level and rehabilitation outcome in older patients has not been fully explored. This study investigated this association in older Chinese patients. We studied 1604 patients in two geriatric convalescence hospitals. Admission albumin levels (g/l) were measured and segregated into three groups: <30 g/l; 30 to <35 g/l; ≥35 g/l. Absolute functional and motor gain were determined by Barthel index (BI) and elderly mobility scale (EMS) and expressed as BI efficacy and EMS efficacy. BI and EMS efficiency were deduced by the efficacy divided by the length of hospital stay (LOS). Satisfactory motor and functional outcomes were defined as discharge EMS ≥ 15 and BI ≥ 75. Significant improvement in EMS and BI scores across all 3 albumin groups on discharge was observed, with lower scores in low albumin groups. The EMS and BI efficacy were the same in 3 albumin groups. However, EMS and BI efficiency were higher in the high albumin groups. Admission albumin was not independent predictors for satisfactory motor and functional outcomes. For satisfactory motor outcome (EMS ≥ 15), female gender ( p = 0.0004), age ( p = 0.0009) and urinary incontinence ( p = 0.0076) were negative predictors while living at home ( p = 0.0028), admission EMS ( p < 0.001) and BI score ( p = 0.0004) were positive predictors. For satisfactory functional outcome (BI ≥ 75), age ( p = 0.015) and urinary incontinence ( p < 0.001) were negative predictors while female gender ( p = 0.0024), LOS ( p = 0.033), C-MMSE ( p < 0.001), admission EMS ( p = 0.003) and BI ( p < 0.001) were positive predictors. Admission albumin levels were related to functional and motor efficiency, but not with absolute functional and motor gain. Albumin was not an independent predictor for satisfactory motor and functional outcome.

Biochemical Markers Predict Morbidity and Mortality after Pancreaticoduodenectomy

The association between routinely ordered perioperative laboratory tests and postoperative morbidity and mortality after pancreaticoduodenectomy has not been well characterized. Routine perioperative laboratory data were analyzed for 2,894 patients who underwent a pancreaticoduodenectomy over a 25-year period. Laboratory values were initially categorized as being above or below the 75th percentile for the study population, and biochemical markers of morbidity and mortality were identified using multivariate logistic regression. The most significant biochemical markers were studied in greater detail by regrouping patients into low, intermediate, and high categories. Significant multivariate predictors of a postoperative complication included preoperative blood urea nitrogen> or =18 mg/dL, preoperative albumin< or =3.5 g/dL, and postoperative amylase> or =292 U/L. Significant multivariate predictors of a postoperative death included preoperative albumin< or =3.5 g/dL and postoperative aminotransferase> or =187 U/L. Postoperative hyperamylasemia was found to be associated, in particular, with an increased pancreatic fistula rate. Pancreatic fistula rates in the low (0 to 99 U/L), intermediate (100 to 399 U/L), and high (> or = 400 U/L) postoperative amylase groups were 4%, 14%, and 20%, respectively. Postoperative mortality rates in patients with low (0 to 499 U/L), intermediate (500 to 1,999 U/L), and high (> or = 2,000 U/L) postoperative aminotransferase groups were 0.9%, 5%, and 29%, respectively. Postoperative mortality rates in the high (> 3.5 g/dL), intermediate (2.6 to 3.5 g/dL), and low (0 to 2.5 g/dL) albumin groups were 0.9%, 3%, and 7%, respectively. Routine perioperative laboratory tests can help surgeons identify patients who are at increased risk for morbidity and mortality after pancreaticoduodenectomy.

Measurements of Serum Free Cortisol in Critically Ill Patients

Patients and Measurements: Baseline serum total cortisol, cosyntropin-stimulated serum total cortisol, aldosterone, and free cortisol concentrations were measured in 66 critically ill patients with an APACHE score of 15 or higher, 33 healthy volunteers, and 7 patients with adrenal insufficiency secondary to hypopituitarism. Patients were further divided into two groups based on their serum albumin concentrations of ≤ 2.5 g/dL (low albumin group, n=36) or >2.5 g/dL (normal albumin group, n=30).

Prognostic Significance of Hypoalbuminemia in Patients with Relapsed/Refractory Hodgkin's Lymphoma (R/R-HL) Undergoing Salvage Autologous Bone Marrow/Peripheral Stem Cell Transplantation (auto-BM/PSCT).

Background: Management of R/R-HL has been disappointing with salvage chemotherapy alone. Although controversy remains over the best time to perform a transplant, auto-BM/PSCT is considered an acceptable salvage therapeutic option for patients (pts) with R/R-HL. Hypoalbuminemia is one of the seven adverse prognostic factors for newly diagnosed pts with HL who receive chemotherapy according to the international prognostic factors project on advanced HL. The prognostic significance of hypoalbuminemia in pts with R/R-HL undergoing salvage auto-BM/PSCT is less clearly defined at the present time.Objective: To evaluate the prognostic significance of hypoalbuminemia in pts with R/R-HL who undergo salvage auto-BM/PSCT.Methods: A retrospective, single-institution study of consecutive pts with R/R-HL who received auto-BM/PSCT at the University of Oklahoma over the last 19 years (1985– 2004) was performed. The serum albumin level during hospital admission for transplant that was closest to, but before, high-dose chemotherapy was recorded and used for this analysis. Hypoalbuminemia was defined as a serum albumin level < 3.5 g/dl. Overall survival (OS) was defined as the time period in months from the day of transplant until death, or the last day of follow-up. Survival curves were estimated according to the Kaplan-Meier method, and were compared between the two groups (control group [≥3.5 g/dl] and low albumin group [< 3.5 g/dl]) with the use of the log-rank test. Median survivals of the two groups were also compared by using Wilcoxon-Mann-Whitney test. One-sided P-value of < 0.05 was considered statistically significant. SAS® sofware (version 8.0; Carry, NC) was used for statistical analysis.Results: 66 patients (40 males, 26 females) were identified, who were 13–69 years old (median 29 years) at the time of transplant. 40 pts (61%) died during follow-up, 4 pts (6%) were lost to follow-up at 15, 27, 58 and 103 months after transplant, and 22 pts (33%) are alive at the time of this analysis (7/30/04), 2–187 months (median 68 months) after transplant. Median survival for the control group (n1=27, 13/27 died) was 78 months (95% CI: 23 - N/A months) and for the low-albumin group (n2=39, 27/39 died) was 22 months (95% CI: 13– 44 months). The difference between overall survival curves (figure) and also the difference between median survivals approached, but did not reach statistical significance (p-values for log-rank and Wilcoxon-Mann-Whitney tests, 0.0632 and 0.0565, respectively).Conclusion: Our results suggest a trend for a worse outcome among pts who undergo salvage auto-BM/PSCT for R/R-HL with low serum albumin (<3.5 g/dl) before transplant. The lack of statistical significance in this analysis is likely related to the relatively limited sample size and the retrospective nature of the study. A larger, prospective analysis evaluating the potential adverse prognostic value of hypoalbuminemia in pts with R/R-HL undergoing auto-BM/PSCT is warranted. [Display omitted]

Association of serum albumin and atherosclerosis in chronic hemodialysis patients

Background: Because cardiovascular disease is the leading cause of death and hypoalbuminemia predicts mortality, hypoalbuminemia may be associated with atherosclerosis. Methods: In 1,411 patients enrolled in the HEMO study, associations of albumin with the presence of coronary artery disease (CAD), cerebrovascular disease (CVD), peripheral vascular disease (PVD), and any one of the three conditions at baseline were examined using multivariable logistic regression models. Results: In the two-slope model, when albumin level was 3.6 g/dL (36 g/L) or greater, with each 1-g/dL (10-g/L) increase in albumin level the odds for CAD (odds ratio [OR], 0.32; 95% confidence interval [CI], 0.17 to 0.59), PVD (OR, 0.39; 95% CI, 0.18 to 0.80), CVD (OR, 0.33; 95% CI, 0.15 to 0.73), and any one of the three conditions (OR, 0.23; 95% CI, 0.12 to 0.44) decreased. When albumin level was less than 3.6 g/dL (36 g/L), none of the conditions was statistically significantly associated with each 1-g/dL (10-g/L) increase in albumin level. When normal- and low-albumin groups were compared with each other, patients with albumin levels less than 3.6 g/dL (36 g/L) had a higher association with CAD (OR, 1.32; 95% CI, 1.03 to 1.70) and for any one of the three conditions (OR, 1.38; 95% CI, 1.07 to 1.78). Conclusion: The odds for atherosclerosis linearly decreased as albumin level increased in the normal-albumin group, and a plateau was seen in the low-albumin group; however, the low-albumin group had significantly greater CAD. The nonlinearity of association of albumin level with prevalence of atherosclerosis might be due to the cross-sectional nature of the study of higher mortality with hypoalbuminemia. © 2002 by the National Kidney Foundation, Inc.

Low molecular weight plasma antioxidants and lipid peroxidation in maternal and cord blood.

To determine the concentrations of the low molecular weight antioxidants urate, bilirubin, albumin and sulphydryl groups and to measure lipid peroxidation levels in pair-matched maternal and cord blood plasma. Venous blood plasma concentrations of urate, bilirubin, albumin and sulphydryls were determined in healthy pregnant women and in pair matched umbilical cords. The ability of maternal and cord plasma to withstand Cu2+-induced lipid peroxidation was assessed by measuring the production of thiobarbituric acid reactive substances (TBARS) over time in plasma incubated with Cu2+. Forty healthy women, between 10 and 20 weeks gestation, were recruited randomly from an antenatal clinic. Venous blood samples were obtained from the mothers at the recruitment stage and from the umbilical cords of their newborn after delivery. Urate, bilirubin and sulphydryls were present in significantly higher concentrations (P<0.001) in cord plasma than in maternal plasma. Albumin levels were similar in mothers and cords. Significantly lower levels (P=0.018) of TBARS were produced in cord plasma compared with maternal plasma following incubation with Cu2+. There were significant correlations between albumin and sulphydryl concentrations in maternal plasma (r 0.43, P=0.007) and between urate concentrations in maternal and cord plasma (r 0.37, P=0.026). Urate, bilirubin and sulphydryls are present in significantly higher concentrations in cord blood than in maternal blood. The increased levels of these antioxidants in cord plasma may contribute to the increased resistance of cord plasma to Cu2+-induced lipid peroxidation.

Mechanisms of hypoalbuminemia in hemodialysis patients

Hypoalbuminemia is the most powerful predictor of mortality in end-stage renal disease. Since protein-calorie malnutrition can decrease albumin synthesis it is assumed that hypoalbuminemia results principally from malnutrition in these patients, but albumin synthesis may also be decreased as part of the acute-phase response, and hypoalbuminemia can also result from redistribution of albumin pools or from albumin losses. We measured albumin synthesis, fractional catabolic rate, and distribution from the turnover of [125I] human albumin in six hemodialysis patients with plasma albumin less than 35 mg/ml and in six patients with plasma albumin greater than 40 mg/ml. Patients with liver disease, HIV, or other infection were excluded. Both groups were maintained with high-flux polysulfone dialyzers for more than three months. Kt/Vurea and PCR were measured during each dialysis (N = 12 to 18/patient). A four-day calorie and protein intake was determined by dietary history and long-term nutritional status was determined anthropometrically. Measured variables included serum urea, creatinine, transferrin, and the positive acute-phase proteins alpha 2- macroglobulin, C-reactive protein, ferritin, and IGF-1. Albumin synthesis was significantly reduced in the low albumin group. There were no differences in dietary intake, body composition, PCR, BUN, creatinine, or Kt/Vurea. Plasma albumin concentration correlated negatively with ferritin, C-reactive protein and alpha 2-macroglobulin. Albumin synthesis rate correlated negatively with both alpha 2-macroglobulin and Kt/Vurea. Both plasma albumin concentration and synthesis rate correlated positively with IGF-1, and both were independent of PCR and all other nutrition-related variables.(ABSTRACT TRUNCATED AT 250 WORDS)

Maintenance of Serum Albumin Levels in Pediatric Burn Patients

A prospective, randomized trial was performed to determine whether maintaining serum albumin levels in burned pediatric patients had any effect on morbidity and mortality. Patients < 19 years of age with burns > 20% total body surface area were randomized to receive supplemental albumin to maintain levels 2.5 to 3.5 g/dL ("High Albumin") or were given albumin only if levels dropped < 1.5 g/dL ("Low Albumin") after completing burn shock resuscitation. The 36 patients in the Low Albumin group were well matched for age, burn size, depth of injury, and inhalation injury when compared with the High Albumin group (34 patients). As expected, serum albumin levels were significantly lower in the Low Albumin group when compared with the High Albumin group. No differences between groups were noted for resuscitation needs, maintenance fluid requirements, urine output, tube feedings received, days of antibiotic treatment, or ventilatory requirements. No differences in hematology, electrolytes, or nutritional laboratories were found. Finally, length of stay, complication rate, and mortality were not affected by albumin treatment. Albumin supplementation to maintain normal serum levels does not seem to be warranted in previously healthy children who suffer severe burns and who receive adequate nutrition.