Lower Serum Albumin Levels Research Articles

Risk factors of mortality following hospital admission for Crohn's disease: A cohort study at a tertiary referral center in Taiwan

AbstractThe prevalence and incidence of Crohn's disease (CD) in Asia is rising, and it is important to know the risk factors of mortality. In our study, CD patients diagnosed and treated in the Chang Gung Memorial Hospital Linkou branch were enrolled from January 1989 to October 2019. The collected data included age, sex, disease duration, location and behavior of the disease, biochemical parameters at admission, medication history, surgical history, and comorbidities. The mean age at diagnosis was 35.7 ± 16.1 years old and the male‐to‐female ratio was 2.4. The penetrating type of CD was the most common (41.3%) of disease behavior. The ileocolonic area is the most common location of disease involvement (79%). 7.7% of patients had low serum albumin levels (<3 g/dL). 16.8% of patients had hemoglobin levels less than 10 g/dL. Of the patients included, 4 died during the follow‐up period. Low serum albumin levels at admission (p = .0307) are an independent predictor for mortality. In conclusion, it is important in perioperative care, especially for CD patients with hypoalbuminemia.

Correlation of nutritional status with clinical characteristics and lung function in children with cystic fibrosis

To investigate the nutritional status of children with cystic fibrosis (CF) and understand the correlation between malnutrition and clinical characteristics as well as lung function. A retrospective analysis was performed on clinical data of CF children admitted from January 2016 to June 2023. Clinical characteristics of CF children with different nutritional statuses were compared, and the correlation between malnutrition and lung function was analyzed. A total of 52 CF children were included, comprising 25 boys (48%) and 27 girls (52%), aged between 7 months and 17 years. Respiratory symptoms were the predominant clinical manifestations (96%, 50/52). The prevalence of malnutrition was 65% (34/52), with moderate/severe malnutrition being the most common (65%, 22/34). The malnutrition group had a longer duration of illness, higher proportion of digestive system symptoms, and lower levels of serum albumin (P<0.05). Pulmonary function parameters, including forced expiratory volume in one second as a percentage of the predicted value, ratio of forced expiratory volume in one second to forced vital capacity, forced expiratory flow at 25% of forced vital capacity exhaled, forced expiratory flow at 50% of forced vital capacity exhaled, forced expiratory flow at 75% of forced vital capacity exhaled, and maximum mid-expiratory flow as a percentage of the predicted value, were lower in the malnutrition group compared to the normal nutrition group (P<0.05). Correlation analysis showed body mass index Z-score was positively correlated with the above six pulmonary function parameters (P<0.05). The prevalence of malnutrition is high in CF children and is associated with decreased lung function. CF children with higher body mass index have better lung function. Therefore, screening and evaluation of nutritional status as well as appropriate nutritional intervention should be emphasized in CF children.

Effects of Switching from Degludec to Glargine U300 in Patients with Insulin-Dependent Type 1 Diabetes: A Retrospective Study.

Background and Objectives: Degludec (Deg) and glargine U300 (Gla-300) are insulin analogs with longer and smoother pharmacodynamic action than glargine U100 (Gla-100), a long-acting insulin that has been widely used for many years in type 1 and type 2 diabetes. Both improve glycemic variability (GV) and the frequency of hypoglycemia, unlike Gla-100. However, it is unclear which insulin analog affects GV and hypoglycemia better in patients with insulin-dependent type 1 diabetes. We evaluated the effects of switching from Deg to Gla-300 on the day-to-day GV and the frequency of hypoglycemia in patients with insulin-dependent type 1 diabetes treated with Deg-containing basal-bolus insulin therapy (BBT). Materials and Methods: We conducted a retrospective study on 24 patients with insulin-dependent type 1 diabetes whose treatment was switched from Deg-containing BBT to Gla-300-containing BBT. We evaluated the day-to-day GV measured as the standard deviation of fasting blood glucose levels (SD-FBG) calculated by the self-monitoring of blood glucose records, the frequency of hypoglycemia (total, severe, and nocturnal), and blood glucose levels measured as fasting plasma glucose (FPG) levels and hemoglobin A1c (HbA1c). Results: The characteristics of the patients included in the analysis with high SD-FBG had frequent hypoglycemic events, despite the use of Deg-containing BBT. For this population, SD-FBG and the frequency of nocturnal hypoglycemia decreased after the switch from Deg to Gla-300. Despite the decrease in the frequency of nocturnal hypoglycemia, the FPG and HbA1c did not worsen by the switch. The change in the SD-FBG had a negative correlation with the SD-FBG at baseline and a positive correlation with serum albumin levels. Conclusions: Switching from Deg to Gla-300 improved the SD-FBG and decreased the frequency of nocturnal hypoglycemia in insulin-dependent type 1 diabetes treated with Deg-containing BBT, especially in cases with low serum albumin levels and a high GV.

Predictive value of serum albumin levels on cancer survival: a prospective cohort study.

Serum albumin levels and cancer mortality are closely related, yet large-sample studies encompassing a broad spectrum of cancer types are lacking. This study encompassed patients diagnosed with cancer across the continuous 10 cycles of NHANES surveys from 1999 to 2018. The study population was stratified into two groups based on median albumin levels (≤ 4.2g/dL and > 4.2 g/dL) or cancer aggressiveness (well-survived cancers and poorly-survived cancers). Survival rates were estimated using the Kaplan-Meier method. The Cox proportional hazards model was employed to evaluate the association between serum albumin levels and cancer mortality. Restricted cubic spline (RCS) analysis was conducted to assess the nonlinear relationship between serum albumin levels and the risk of cancer mortality. Kaplan-Meier curves demonstrated that patients with albumin levels ≤ 4.2 g/dL exhibited lower survival rates compared to those with levels > 4.2 g/dL, irrespective of cancer aggressiveness. Following adjustment for confounders, decreased albumin levels were associated with an elevated risk of cancer mortality across all groups [all cancers, HR (95%CI) = 2.03(1.73, 2.37); well survived cancers, HR (95%CI) = 1.78(1.38, 2.32); and poorly survived cancers, HR (95%CI) = 1.99(1.64, 2.42)]. RCS analyses revealed a stable nonlinear negative association between albumin levels and cancer mortality in all groups, regardless of confounder adjustment. Low serum albumin levels predict higher cancer mortality. Furthermore, a nonlinear negative association was observed between serum albumin levels and the risk of cancer mortality.

The relationship between albumin level and the development of acute kidney injury and mortality in critically COVID-19 patients

Aims: The impact of the Coronavirus Pandemic, which began in 2019, has considerably diminished; however, its effects still persist. While respiratory symptoms have been prominent during the pandemic, acute kidney disease has emerged as a significant contributor to morbidity and mortality. This study aims to demonstrate that serum albumin levels can serve as a predictor for acute kidney injury (AKI) and mortality, owing to their cost- effectiveness and feasibility for use across various healthcare centers. The goal is to contribute to the reduction of AKI development and mortality rates. Methods: The study was conducted by analyzing data from a total of 350 patients admitted to intensive care units of a training and research hospital due to COVID-19 between March 1, 2020, and April 30, 2021. Of these patients, 179 (51%) were male, and 171 (49%) were female. The data were examined retrospectively. Patients were categorized into two groups based on serum albumin levels: ?2.5 mg/dl (severe hypoalbuminemia) and 2.5-3.5 mg/dl (mild hypoalbuminemia). Subsequently, the patients were further categorized into groups based on the presence or absence of AKI, and these groups were statistically compared. Demographic data, clinical information, and laboratory values of the patients were assessed. The diagnosis of acute kidney injury (AKI) was made according to KDIGO criteria. Data were compared using the SPSS version 24 software. Results: Among the 350 patients included in the study, 115 had serum albumin levels ?2.5 mg/dl (severe hypoalbuminemia), and 235 had levels in the range of 2.5-3.5 mg/dl (mild hypoalbuminemia). Among those who developed AKI, the average albumin level was found to be 2.68 mg/dl, whereas in the group without AKI, the average albumin level was 2.76 mg/dl. Out of the total, 201 (57%) patients developed AKI, and 82% of them experienced mortality. In contrast, among the 149 (43%) patients who did not develop AKI, the mortality rate was 42%. Further subgroup analysis revealed the highest mortality rate of 88% among patients with severe hypoalbuminemia and AKI development. Conversely, the lowest mortality rate of 40% was observed in patients with mild hypoalbuminemia and no AKI. Conclusion: This study aims to establish that low serum albumin levels should be regarded not only as a negative acute-phase reactant but also as a predictive factor for complications including acute kidney disease development and mortality. Lower albumin values are correlated with higher complication rates and increased mortality. Additionally, due to its widespread availability and low cost, serum albumin is a cost-effective diagnostic tool that can be utilized in almost any healthcare setting.

Neither hepatic steatosis nor fibrosis is associated with clinical outcomes in patients with intestinal Behçet's disease.

Behçet's disease (BD) and nonalcoholic fatty liver disease (NAFLD) are chronic inflammatory diseases that share pathogenetic mechanisms. In this study, we investigated whether NAFLD influences the clinical outcomes in patients with intestinal BD. Patients with intestinal BD and available hepatic steatosis index (HSI) and fibrosis-4 (FIB-4) scores were recruited between 2005 and 2022. An HSI of ≥30 and FIB-4 of ≥1.45 were used to diagnose hepatic steatosis and significant liver fibrosis, respectively. The primary outcomes were intestinal BD-related hospitalization, surgery, emergency room visits, or the first use of corticosteroids, immunomodulators, or biologic agents for intestinal BD. A total of 780 patients with BD were selected. The prevalence of hepatic steatosis and significant liver fibrosis were 72.3% and 8.8%, respectively. Multivariate analysis showed that younger age, prior smoking history, concomitant skin lesions, higher white blood cell count, and lower serum albumin levels were independently associated with an increased risk of clinical relapse (all P < 0.05), whereas hepatic steatosis and significant liver fibrosis were not (hazard ratio [HR] = 1.164, 95% confidence interval [CI] 0.923-1.468; P = 0.199 for hepatic steatosis; HR = 0.982, 95% CI 0.672-1.436; P = 0.927 for significant liver fibrosis). Hepatic steatosis and liver fibrotic burden were not independently associated with clinical outcomes in patients with intestinal BD.

Hypothyroidism among children and adolescents with nephrotic syndrome in Mulago National Referral Hospital, Kampala, Uganda; a cross-sectional study

BackgroundNephrotic syndrome (NS) is the commonest glomerular disease among children. It is characterized by heavy proteinuria and is a risk factor for hypothyroidism in the affected children. Hypothyroidism is of concern because it affects the physical and intellectual development of children and adolescents. This study sought to establish the prevalence and factors associated with hypothyroidism among children and adolescents with NS.MethodsA cross-sectional design was used to study 70 children and adolescents aged 1–19 years diagnosed with nephrotic syndrome and being followed up in the kidney clinic in Mulago National Referral Hospital. Questionnaires were used to collect patients’ socio-demographics and clinical information. A blood sample was taken for analysis for thyroid stimulating hormone (TSH) and free thyroxine (FT4), renal function tests and serum albumin. Hypothyroidism included both overt and subclinical forms. Overt hypothyroidism was defined as TSH level > 10 mU/L and FT4 < 10pmol/L, or FT4 < 10pmol/l with normal TSH, or TSH < 0.5mU/l. Sub-clinical hypothyroidism was defined as TSH ranging between 5 and10 mU/L with normal age appropriate FT4 levels. Urine samples were collected and taken for a dipstick examination. The data was analyzed using STATA version 14. The Bayesian Logistic regression analysis approach was used to estimate odds ratios (OR) and their associated 95% credible intervals. All predictor variables with p value < 0.05 at frequentist statistical analysis were considered significant.ResultsThe mean age (standard deviation) of participants was 9 years (3.8). There were more males; 36 of 70 (51.4%). The prevalence of hypothyroidism was 23% (16/70 participants). Of the 16 children with hypothyroidism, 3 (18.7%) had overt hypothyroidism while 13 had subclinical hypothyroidism. Only low serum albumin was found to be strongly associated with hypothyroidism; Bayesian OR 132.57 (CI 9.13–567.10) with a frequentist OR of 37 and a p value of 0.001.ConclusionThe prevalence of hypothyroidism among children and adolescent with nephrotic syndrome attending Mulago Hospital paediatric kidney clinic was 23%. Hypoalbuminemia was found to be associated with hypothyroidism. Therefore, children and adolescents that have severely low levels of serum albumin should be screened for hypothyroidism and linked to endocrinologists for care.

Prevalence and immunopathologic characteristics of seropositive and seronegative hepatitis B virus-associated membranous nephropathy: a retrospective study of 420 biopsy-proven cases

Background This retrospective study aims to investigate the prevalence and immunopathologic characteristics of seropositive and seronegative hepatitis B virus-associated membranous nephropathy (HBV-MN). Methods Clinicopathologic and serologic records of 420 patients with histologically confirmed HBV-MN between January 2014 and July 2021 were examined to determine the prevalence of seropositive and seronegative HBV-MN. Serum anti-PLA2R antibody testing was conducted on 280 patients with HBV-associated membranous nephropathy (HBV-MN) from August 2018 to July 2021. Immunopathologic characteristics of HBV-MN patients and anti-PLA2R antibody positivity were analyzed. Results Among 420 pathologically confirmed HBV-MN patients, 230 (54.8%) were seropositive for HBV. The seropositive group exhibited higher blood creatinine values and incidence of liver function abnormalities than the seronegative group (p < .05). Serum anti-PLA2R antibody testing on 280 HBV-MN patients revealed a total positive rate of 44.6%, with the seronegative group showing a significantly higher rate (62.6%) compared to the seropositive group (32.1%) (p < .01). The anti-PLA2R antibody-positive group displayed higher levels of urine protein (p < .05), serum cholesterol (p < .01), and IgG4 subtypes (p < .05) compared to the negative group. Additionally, the positive group had significantly lower levels of serum albumin and IgG than the negative group (p < .01). Conclusions This comprehensive study reveals a significantly higher prevalence of seronegative HBV-MN than previously thought. The blood creatinine values and incidence of liver function abnormalities was higher in the serology-positive group than in the serology-negative group. Notably, the seronegative group displayed a higher positive rate of anti-PLA2R antibodies compared to the seropositive group, indicating distinctive clinical and immunopathologic features.

Multisystem Inflammatory Syndrome in Children and Cardiac Involvement: A Quaternary Center Experience.

We prospectively analyzed clinical and laboratory characteristics associated with cardiac involvement and severe presentation in multisystem inflammatory syndrome in children. Of 146 patients, 66 (45.2%) had cardiac dysfunction and 26 (17.8%) had coronary artery abnormalities. Lower serum albumin levels, absolute lymphocyte and platelet counts, and elevated ferritin, fibrinogen, d-dimer and interleukin-6 levels were associated with cardiac dysfunction. Possible treatment complications were identified.

Morbidity and mortality in adults with a Fontan circulation beyond the fourth decade of life.

To evaluate the late outcomes of adults (above 35 years) with a Fontan-type circulation, for whom current data on morbidity and mortality are lacking. Data were collected retrospectively on consecutive patients with Fontan circulation above the age of 35 years followed in three European specialist centres. Overall, 115 Fontan patients were included [median age 35 (range 35-48) years, 47.8% female]. The most common underlying congenital heart disease diagnosis was tricuspid atresia (n = 58, 50.4%), and the age at first Fontan completion was 9.1 (interquartile range 5.0-15.8) years. Almost two-thirds (61.7%) of patients had undergone an atriopulmonary Fontan, and 23.5% had received a total cavopulmonary connection. One-third required repeat surgery or intervention. Most patients (55.9%) were in New York Heart Association functional class II or class I (30.6%), 76 (66.1%) patients had experienced at least one arrhythmia, and eight (7.0%) protein-losing enteropathy. At a median follow-up of 5.0 (2.4-10.3) years, 15 (13.0%) patients were referred for transplantation assessment and 19 (16.5%) patients died, mainly from heart failure (84.2%). Univariable predictors of death or transplantation included lower serum albumin level [hazard ratio (HR) 1.09 per g/L decrease, 95% confidence interval (CI): 1.04-1.15, P = 0.0009], prior heart failure admission (HR 4.28, 95% CI:1.75-10.44, P = 0.001), prior atrial tachycardia or flutter (HR 3.02, 95% CI: 1.23-7.38, P = 0.02), and baseline pulmonary vasodilator therapy (HR 8.59, 95% CI:1.05-70.13, P = 0.04). Lower serum albumin and prior atrial tachycardia or flutter remained significant on bivariable analysis. Our study highlights the significant morbidity and mortality in older adults with a Fontan-type circulation, emphasizing the need for lifelong specialist surveillance with frequent risk stratification, close monitoring, and early consideration for transplantation assessment.

Abstract TP254: The Incidence Rate and Risk Factors of In-Hospital Onset Stroke Among 83,990 Hospitalized Patients

Introduction: Clinical characteristics of patients with in-hospital onset stroke (IHOS) compared to those with out-of-hospital onset stroke are reported to be late detection of stroke onset, less use of rt-PA, presence of atrial fibrillation, and poor outcome. Among hospitalized patients, however, clinical characteristics of patients with IHOS has not been clear. The purpose of this study is to clarify the incidence rate of IHOS among hospitalized patients and to investigate the risk factors associated with IHOS. Methods: Patients consecutively admitted to the Nippon Medical School hospital between April 2018 and March 2023 were assessed. Patients under 18 years and discharged within 24 hours were excluded. Furthermore, patients admitted in Neurology and Neurosurgery also were excluded to remove in-hospital onset recurrent stroke from our study. First, we calculated the incidence rate of IHOS among hospitalized patients. Next, all patients were divided into two groups, Stroke group had IHOS and Control group did not, and investigated the risk factors associated with IHOS using multivariate analysis. Results: Of 98,225 patients hospitalized, 83,990 patients (median age was 69 [54-77] years and 55.3% were male) were enrolled into this study. The number of IHOS patients were 101. Thus, the incidence rate of IHOS was 0.12%. A half of them (n=49) had stroke onset within 1 week after admission. Stroke group had higher mortality (14.9% vs. 2.7%, p &lt; 0.01) and longer length of stay (36 days vs. 8 days, p &lt; 0.01) than Control group. Multivariate analysis demonstrated that risk factors associated with IHOS were old age (OR 1.03, p &lt; 0.01), hypertension (OR 1.57, p = 0.04), diabetes mellitus (OR 1.61, p = 0.03), atrial fibrillation (OR 2.43, p &lt; 0.01), emergency admission (OR 3.38, p &lt; 0.01) and low serum albumin level (OR 0.66, p = 0.03). Conclusions: Among 83,990 hospitalized patients, the incidence rate of IHOS was 0.12%. Risk factors associated with IHOS were old age, hypertension, diabetes mellitus, atrial fibrillation, emergency admission and low serum albumin level. Therefore, among hospitalized patients, cases with emergency admission and cerebrovascular risk factors including atrial fibrillation should be payed attention to prevent in-hospital onset stroke.

Comparison of survival prediction models for bone metastases of the extremities following surgery.

This study aimed to compare the performance of survival prediction models for bone metastases of the extremities (BM-E) with pathological fractures in an Asian cohort, and investigate patient characteristics associated with survival. This retrospective cohort study included 469 patients, who underwent surgery for BM-E between January 2009 and March 2022 at a tertiary hospital in South Korea. Postoperative survival was calculated using the PATHFx3.0, SPRING13, OPTIModel, SORG, and IOR models. Model performance was assessed with area under the curve (AUC), calibration curve, Brier score, and decision curve analysis. Cox regression analyses were performed to evaluate the factors contributing to survival. The SORG model demonstrated the highest discriminatory accuracy with AUC (0.80 (95% confidence interval (CI) 0.76 to 0.85)) at 12 months. In calibration analysis, the PATHfx3.0 and OPTIModel models underestimated survival, while the SPRING13 and IOR models overestimated survival. The SORG model exhibited excellent calibration with intercepts of 0.10 (95% CI -0.13 to 0.33) at 12 months. The SORG model also had lower Brier scores than the null score at three and 12 months, indicating good overall performance. Decision curve analysis showed that all five survival prediction models provided greater net benefit than the default strategy of operating on either all or no patients. Rapid growth cancer and low serum albumin levels were associated with three-, six-, and 12-month survival. State-of-art survival prediction models for BM-E (PATHFx3.0, SPRING13, OPTIModel, SORG, and IOR models) are useful clinical tools for orthopaedic surgeons in the decision-making process for the treatment in Asian patients, with SORG models offering the best predictive performance. Rapid growth cancer and serum albumin level are independent, statistically significant factors contributing to survival following surgery of BM-E. Further refinement of survival prediction models will bring about informed and patient-specific treatment of BM-E.

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.

Clinical characteristics of hemophagocytic lymphohistiocytosis.

There is no specificity in the clinical presentation of hemophagocytic lymphohistiocytosis (HLH). To study some clinical, etiological, and prognostic features of HLH to improve the clinical understanding of the disease. Retrospective analysis of the clinical data of 125 patients with HLH admitted to our hospital from June 2015 to August 2021, including clinical characteristics, laboratory indicators, and survival period. Statistical analysis was performed from the overall group of study indicators, which included population, children, and adults. In the whole population, sex, age, blood myoglobin, and NK cell ratio of M-HLH and non-M-HLH patients (P< 0.05), serum albumin, and direct bilirubin were independent correlates of M-HLH. In the pediatric group, age and the proportion of NK cells were significantly different between M-HLH and non-M-HLH patients (P< 0.05). Multivariate Logistic regression analysis showed that all factors were not significantly associated with M-HLH. The associated regression analysis showed that all factors were not significantly associated with M-HLH. ROC curve analysis showed that the best predictive value of NK cell percentage for M-HLH diagnosis in the overall population was 4.96% in the pediatric group and 4.96% in the adult group. The best predictive value for M-HLH diagnosis was 2.08%. The univariate analysis showed that platelet count, alanine aminotransferase, aspartate aminotransferase, serum albumin, direct bilirubin and indirect bilirubin affected prognosis; COX regression showed that none of these factors had a significant relationship. The overall median survival time was 20.7 months in the adult group, 44.3 months in non-M-HLH patients, and 7.73 months in M-HLH patients (p= 0.011); univariate analysis showed that platelet count and serum albumin level affected prognosis; COX regression results in serum albumin level was an independent risk factor for prognosis. The survival rate of non-M-HLH was significantly better than that of M-HLH; the proportion of NK cells had predictive value for the diagnosis of M-HLH; in the general population, non-M-HLH was more likely to have abnormal liver function than M-HLH: lower platelet count and serum albumin level were associated with poor prognosis, and the lower the platelet count and serum albumin level, the worse the prognosis: in addition, adults with lower serum albumin levels are also associated with poor prognosis.

P937 A Retropective Analysis of Micronutrient Status in Inflammatory Bowel Disease

Abstract Background Researchers are increasingly focusing on the influence of micronutrient levels on the initiation and prognosis of Inflammatory Bowel Disease (IBD). Earlier investigations have highlighted a connection between deficiencies in zinc and selenium and an elevated risk of IBD development and unfavorable outcomes. This study seeks to investigate the existing micronutrient status among Chinese patients with IBD and assess whether deficiencies in trace elements are associated with disease activity, extent of intestinal involvement, and the use of biological treatments. Methods This cross-sectional study included patients diagnosed with Crohn's disease (CD) or ulcerative colitis (UC) who underwent plasma micronutrient testing during outpatient or inpatient visits to the Department of Gastroenterology at Peking Union Medical College Hospital from May 2022 to October 2023. Baseline data, the history of biological agent use, and laboratory inflammation parameters such as hsCRP, ESR, and Alb were extracted from the Electronic Medical Record System. Colonoscopy images were examined to assess the extent of intestinal involvement and endoscopic activity. The distribution of micronutrient deficiency among patients with varying disease statuses was explored using the Pearson chi-square test and Mann-Whitney U-test. Results Among the 168 participants with IBD in this study (77 with CD, 91 with UC), a frequent occurrence of deficiencies in copper, selenium, strontium, and zinc was noted. In CD patients in the endoscopic active phase, there was a higher incidence of selenium and zinc deficiencies compared to the remission phase (selenium 0% vs. 11.3%, p=0.17; zinc 4.2% vs. 24.5%, p=0.052). In UC patients during the endoscopic active phase, strontium (14.5% vs. 0%, p=0.053) and zinc (17.7% vs. 3.4%, p=0.094) deficiencies were more likely to occur. CD patients with zinc deficiency and UC patients lacking zinc or selenium showed higher levels of blood hsCRP and ESR but lower levels of serum albumin. UC patients with E3 type involvement were more prone to selenium and strontium deficiencies compared to those with only left colon involvement (selenium 18.5% vs. 2.7%, p=0.025; strontium 14.8% vs. 5.0%, p=0.078). Conclusion This study identified a notable prevalence of micronutrient deficiencies in individuals with IBD, particularly during active phases. Specifically, patients with CD in an inflammatory state are inclined to exhibit zinc deficiency. In the case of UC, the absence of selenium, strontium, and zinc signals a higher level of inflammation. UC patients with involvement of the entire colon are more prone to experiencing deficiencies in selenium and strontium. These findings warrant validation through multi-center study and mechanism invetigation.

P361 Neither hepatic steatosis nor fibrosis is associated with clinical outcomes in patients with intestinal Behçet’s disease

Abstract Background Behçet’s disease (BD) and nonalcoholic fatty liver disease (NAFLD) are chronic inflammatory diseases that share pathogenetic mechanisms. In this study, we investigated whether NAFLD influences the clinical outcomes in patients with intestinal BD. Methods Patients with intestinal BD and available hepatic steatosis index (HSI) and fibrosis-4 (FIB-4) scores were recruited between 2005 and 2022. An HSI of ≥30 and FIB-4 of ≥1.45 were used to diagnose hepatic steatosis and significant liver fibrosis, respectively. The primary outcomes were intestinal BD-related hospitalization, surgery, emergency room visits, or the first use of corticosteroids, immunomodulators, or biologic agents for intestinal BD. Results A total of 780 patients with BD were selected. The prevalence of hepatic steatosis and significant liver fibrosis were 72.3% and 8.8%, respectively. Multivariate analysis showed that younger age, prior smoking history, concomitant skin lesions, higher white blood cell count, and lower serum albumin levels were independently associated with an increased risk of clinical relapse (all p &amp;lt;0.05), whereas hepatic steatosis and significant liver fibrosis were not (hazard ratio [HR] = 1.164, 95% confidence interval [CI] 0.923–1.468; p = 0.199 for hepatic steatosis; HR = 0.982, 95% CI 0.672–1.436; p = 0.927 for significant liver fibrosis). Conclusion Hepatic steatosis and liver fibrotic burden were not independently associated with clinical outcomes in patients with intestinal BD.

P1001 Predictive factors of colectomy in patients admitted with Acute Severe Ulcerative Colitis

Abstract Background Acute severe ulcerative colitis (ASUC) is a life-threatening condition which requires quick decision making and urgent treatment. To facilitate this process, it is essential to identify patients at a high risk of emergency colectomy. The aim of this study is to identify predictors for emergency colectomy in patients with ASUC. Methods A retrospective study of 121 patients admitted with ASUC to a single gastroenterology centre between 2010 and 2020 was performed. Clinical and demographic data, laboratory and endoscopic examinations results were analysed as potential predictors of colectomy. Albumin and C-reactive protein (CRP) levels were recorded at baseline and at the 3rd day after intravenous steroids (IVS) initiation. Results 119 patients initially received IVS, while 2 patients with suspected intestinal perforation underwent emergency colectomy on the first day. 64 (53%) were women, with a median age of all patients of 33 (IQR 27-49) yrs. 15 (12.4%) patients admitted with ASUC underwent colectomy, while mortality rate during hospitalization was 1.7%. During the entire follow-up period, with a median duration of 46.5 months (23-88.25), colectomy was performed in 19 (15.7%) patients. Overall, in the study group, colectomy rate at 1 month, 3 months and 2 years were 12.4%, 12.4%, and 14.0%, respectively. Assessing further outcomes after colectomy, during the follow-up period, 13 (68.4%) achieved clinical remission, 1 died during the operation, and 5 (26.3%) patients still have an active course of the disease requiring immunosuppressive treatment. When comparing patients in the colectomy group (n=13) with patients who avoided colectomy during this hospitalization (n=105), no significant differences were found in age, sex, duration of illness, body mass index, endoscopic activity, the use of prednisolone or azathioprine prior to admission or previous treatment with biologics. The presence of cytomegalovirus and Clostridium difficile infection was also not associated with a higher risk of colectomy. Significant differences between the groups were found comparing the laboratory findings: the strongest predictor of colectomy was the CRP/albumin ratio at day 3 after IVS initiation (median value was 1.26 (0,81-3,26) in colectomy group vs. 0,64 (0,25-1,36) in non-colectomy group, p&amp;lt;0.001). The difference was also observed when comparing albumin (median 26 (24-28) vs. 29 (27-32), p=0.012) and CRP (median 33 (25-83) vs. 16 (8-37), p=0.003) levels separately on the 3rd day, while at baseline there was no significant differences in laboratory findings. Conclusion A low serum albumin level, higher CRP and CRP/albumin ratio are predictive factors of emergency colectomy in ASUC patients.

Podocyte-specific Nup160 knockout mice develop nephrotic syndrome and glomerulosclerosis.

More than 60 monogenic genes mutated in steroid-resistant nephrotic syndrome (SRNS) have been identified. Our previous study found that mutations in nucleoporin 160 kD (NUP160) are implicated in SRNS. The NUP160 gene encodes a component of the nuclear pore complex. Recently, two siblings with homozygous NUP160 mutations presented with SRNS and a nervous system disorder. However, replication of nephrotic syndrome (NS)-associated phenotypes in a mammalian model following loss of Nup160 is needed to prove that NUP160 mutations cause SRNS. Here, we generated a podocyte-specific Nup160 knockout (Nup160podKO) mouse model using CRISPR/Cas9 and Cre/loxP technologies. We investigated NS-associated phenotypes in these Nup160podKO mice. We verified efficient abrogation of Nup160 in Nup160podKO mice at both the DNA and protein levels. We showed that Nup160podKO mice develop typical signs of NS. Nup160podKO mice exhibited progression of proteinuria to average albumin/creatinine ratio (ACR) levels of 15.06 ± 2.71mg/mg at 26weeks, and had lower serum albumin levels of 13.13 ± 1.34g/l at 30weeks. Littermate control mice had urinary ACR mean values of 0.03mg/mg and serum albumin values of 22.89 ± 0.34g/l at the corresponding ages. Further, Nup160podKO mice exhibited glomerulosclerosis compared with littermate control mice. Podocyte-specific Nup160 knockout in mice led to NS and glomerulosclerosis. Thus, our findings strongly support that mutations in NUP160 cause SRNS. The newly generated Nup160podKO mice are a reliable mammalian model for future study of the pathogenesis of NUP160-associated SRNS.

Predictors of renal flares in systemic lupus erythematosus: a post-hoc analysis of four phase III clinical trials of belimumab.

To identify predictors of renal flares in patients with SLE treated for active extra-renal disease. Data from four clinical trials of belimumab in SLE (BLISS-52, NCT00424476; BLISS-76, NCT00410384; BLISS-NEA, NCT01345253; BLISS-SC, NCT01484496) were used. Patients were assigned to belimumab or placebo on top of standard therapy. We investigated the performance of predictors of renal flares through 52-76 weeks using proportional hazards regression analysis. Of 3225 participants, 192 developed at least one renal flare during follow-up, with the first occurring after a median time of 197 days. Current/former renal involvement (HR: 15.4; 95% CI: 8.3-28.2; p< 0.001), low serum albumin levels (HR 0.9; 95% CI: 0.8-0.9; p< 0.001), proteinuria (HR: 1.6; 95% CI: 1.5-1.7; p< 0.001), and low C3 levels (HR: 2.9; 95% CI: 2.1-4.1; p< 0.001) at baseline appeared robust determinants of renal flares. Anti-dsDNA positivity yielded an increased hazard for renal flares (HR: 2.1; 95% CI: 1.4-3.2; p< 0.001), which attenuated after adjustments. Anti-Sm positivity was associated with renal flares in the placebo (HR: 3.7; 95% CI: 2.0-6.9; p< 0.001) but not in the belimumab subgroup, whereas anti-ribosomal P positivity was associated with renal flares in the belimumab subgroup only (HR: 2.8; 95% CI: 1.5-5.0; p= 0.001). A history of renal involvement, high baseline proteinuria, hypoalbuminaemia, and C3 consumption were robust determinants of impending renal flares. Beyond anti-dsDNA, anti-Sm and anti-ribosomal P protein antibody positivity may have value in surveillance of renal SLE.

Impact of Serum Albumin Levels and Body Mass Index on Outcomes of Open Abdominal Aortic Aneurysm Repair in Korean Population

Although obese patients seem to be susceptible to chronic diseases, obesity paradox has been observed in the field of vascular surgery, in which many previous studies have reported that overweight patients have good postoperative outcomes and underweight patients have poor postoperative outcomes. The purpose of our study is to evaluate the impact of body mass index (BMI) and serum albumin levels, which are evaluated as indicators of nutritional status, on outcomes of open abdominal aortic aneurysm (AAA) repair. We reviewed the vascular surgery database of a single tertiary referral center for all patients who underwent open AAA repair due to degenerative etiology from 1996 to 2021. To analyze the effect of BMI, patients were classified into 4 groups according to the Asian-Pacific classification of BMI: underweight (UW) (<18.5kg/m2), normal weight (NW) (18.5-22.9kg/m2), overweight (OW) (23-24.9kg/m2), and obese (OB) (≥25kg/m2). The χ2, Fisher's exact, and Kruskal-Wallis tests were used to compare demographics, comorbidities, radiologic findings, surgical details, and 1-year mortality rates between the 4 groups. We also compared the preoperative serum albumin levels of each group to assess nutritional status indirectly. Cox's proportional hazards model was performed to determine factors associated with mortality. A Kaplan-Meier survival analysis was performed, and the differences were analyzed by a log-rank test. We did not perform an analysis for 30-day mortality because cases of 30-day mortality in UW patients were rare due to the unbalanced distribution of the number of patients in the 4 groups. Among a total of 678 patients, 22 were classified as UW (3.2%), 200 as NW (29.5%), 183 as OW (27.1%), and 273 as OB (40.1%). The median age was 70 (64-75) years and 577 of 678 (85.1%) patients were male gender. Higher serum albumin level was associated with decreased 1-year mortality (hazard ratio [HR], 0.3; 95% confidence interval [CI], 0.15-0.63; P=0.001). UW patients had a higher 1-year mortality rate than NW patients (HR, 3.67; 95% CI, 1.02-13.18; P=0.046). OB patients had a lower overall mortality rate than NW patients (HR, 0.73; 95% CI, 0.53-1; P=0.05). Low BMI (<18.5kg/m2) and low serum albumin level were associated with poor 1-year survival after elective open AAA repair. These patients also need more careful preoperative intervention, like weight gain or nutritional support, for better outcomes. The obesity paradox existed in our study; high BMI (≥25kg/m2) was associated with better overall survival after elective open AAA repair.