Mean Albumin Level Research Articles

P0924 Efficacy and Safety Assessment of Ustekinumab in Postoperative Crohn’s Disease Patients in China

Abstract Background Crohn’s disease (CD) poses a significant risk of postoperative recurrence (POR), complicating management, and data on the use of Ustekinumab (UST) in postoperative CD patients in China is limited. This study evaluated the efficacy and safety of UST in preventing POR. Methods This multicenter, retrospective observational study involved postoperative CD patients from four Chinese tertiary hospitals, all of whom had at least two high-risk recurrence factors. Patients who failed anti-TNF-α treatments or Vedolizumab switched to UST as non-first-line therapy, while others received UST as first-line treatment at least two weeks post-surgery. Efficacy was evaluated using endoscopic success (Rutgeerts score) and clinical disease activity (Harvey-Bradshaw Index [HBI]), with safety determined by adverse events after a minimum follow-up of 24 weeks. Results This study included 53 patients with a mean age of 36.8 years. Significant improvement in the Rutgeerts score was observed (p < 0.001). The remission rate (i0) increased from 0.0% to 32.1% post-treatment. Notable changes were seen in i1 (from 5.7% to 32.1%) and i2 (from 49.1% to 28.3%), while severe disease cases (i3 and i4) declined significantly. Overall, the endoscopic success rate was 83.0%. Similarly, the HBI score significantly improved (mean ± SD: 6.1 ± 2.5 before vs. 2.4 ± 1.7 after, p < 0.001). The median HBI decreased from 6.0 to 2.0, with remission rates rising from 18.9% to 90.6%, while active disease cases fell from 81.1% to 9.4% (p < 0.001). The percent of 90.3 in the first-line group experienced a decrease in their Rutgeerts score, compared to 72.7% in the second-line group, though this difference was also not statistically significant (p = 0.093). A significant difference was noted in HBI scores (p = 0.016), with the first-line group’s mean at 1.9 ± 1.3 being significantly lower than the second-line group’s 3.1 ± 1.9. The median HBI followed this trend, with values of 2.0 for the first-line and 3.0 for the second-line group. The mean BMI increased from 19.9 ± 3.8 to 21.1 ± 3.7, though not significantly (p = 0.078). Nutritional status improved, as indicated by increased mean albumin (41.3 ± 15.2 vs. 43.7 ± 15.3, P = 0.043) and hemoglobin levels (116.6 ± 24.9 vs. 125.9 ± 23.9, P = 0.019). Only one adverse event, secondary kidney function impairment, was reported. Conclusion UST exhibited significant efficacy in preventing POR of CD with a favorable safety profile, whether used as a first-line or non-first-line treatment. Our research provided essential evidence from an Eastern population regarding the effectiveness and safety of UST in postoperative CD patients. References Torres J, Bonovas S, Doherty G, et al. ECCO Guidelines on Therapeutics in Crohn’s Disease: Medical Treatment. J Crohns Colitis. 2020. 14(1): 4-22.

P0397 Nutritional status and the risk of proctectomy in patients with perianal fistulising Crohn’s disease

Abstract Background Perianal fistulas are the most common type of anal involvement in Crohn’s disease (CD), affecting approximately one-third of the patients.1 They are associated with a poor quality of life and can lead to significant disability.2 Despite combined medical and surgical treatments, many patients experience refractory disease, with up to 20% requiring proctectomy, which results in a permanent stoma.3 Consequently, investigating factors that may influence the outcomes of perianal disease is a critical area of research in CD. One such factor that remains to be explored is the impact of nutritional status on fistula healing and the overall prognosis of patients with perianal CD.4 This study aimed to evaluate how nutritional status influences the risk of undergoing proctectomy. Methods A retrospective cohort study was conducted with 64 patients with CD presenting chronic symptomatic anorectal fistulas. These patients underwent seton placement at two healthcare centres in Brasília, DF, Brazil, from January 2010 to December 2022. Data were extracted from the electronic patient records, including demographic and clinical characteristics. At the first hospital admission, nutritional risk screening was evaluated by applying the NRS-2002. The nutritional status was assessed retrospectively using the GLIM criteria. The prevalence of malnutrition and its association with the risk of proctectomy were analysed. Binary logistic regression with univariate analysis was used to screen independent risk factors for building a final multivariate model by including variables with clinical or statistical significance. Results Seventeen out of sixty-four patients were diagnosed with malnutrition (26.6%). The median follow-up was 53 months. The malnourished group had a higher prevalence of proctitis (100% vs 78.7%, p= 0.038) and lower mean albumin (34.7 vs 39.7 g/L, p= 0.002) and haemoglobin levels (10.9 vs 12.5 g/dL, p=0.003). Malnourished patients were younger at diagnosis (24.2 vs 30y, p=0.046) and presented lower BMI (19.7 vs 24.9 kg/m², p<0.001), higher Harvey-Bradshaw Index levels (10 vs 5, p<0.001) and rates of corticosteroid therapy (29.4% vs 4.3%, p= 0.012). The proctectomy rate was 47.1% in the malnourished group compared to 14.9% in non-malnourished patients (p=0.007). The binary logistic regression results indicated that malnutrition (OR=6.24; 95% CI= 1.27 - 30.57; p=0.024) was an independent risk factor for proctectomy. Conclusion Malnutrition, as assessed by GLIM criteria, was a significant risk factor for a proctectomy procedure in patients with CD presenting chronic symptomatic perianal fistulas. Future research should examine whether nutritional interventions can improve the prognosis of patients with perianal fistulising CD.

Association between serum albumin levels at admission and clinical outcomes in pediatric intensive care units: a multi-center study

BackgroundAlbumin, a vital component in regulating human blood oncotic pressure, plays an important role in the prediction of prognosis in pediatric patients.Previous research identified significant differences in serum albumin levels of healthy and critically ill children.MethodsThe present study aims to investigate the correlation between albumin levels measured during pediatric intensive care unit(PICU) admission and clinical outcomes. In 2022, a comprehensive analysis of the records was conducted retrospectively in four tertiary hospital PICUs in different cities in the south-east region of Turkey. We then conducted a ROC analysis to predict mortality based on hypoalbuminemia.A cut-off value was determined, and the patients were divided into two groups: hypoalbuminemic and normoalbuminemic.Based on this cut-off level, we evaluated the association between admission serum albumin levels and mortality, length of stay, laboratories, need for mechanical ventilation, and extracorporeal treatments.ResultsA total of 1329 patients admitted to the PICUs between January 1, 2022 and January 1, 2023 were included. The mortality rate amounted to 16.2%.The mean albumin level was 4.03 ± 0.69 g/dl in the surviving and 3.35 ± 0.90 g/dl in the non-surviving group(p < 0.001).The average length of stay in the PICU amounted to 8.98 ± 17.07, while the mean length of hospital stay was 11.23 ± 18.81days.Patients with hypoalbuminemia had significantly longer stays in the PICU and hospital as compared to those with normal albumin levels(p = 0.025 and p < 0.001,respectively).We found robust evidence that albumin levels are a strong predictor of mortality, with a predictive rate of 84.5%(OR:0.322, 95% CI:0.263–0.395, p < 0.001).The cut-off value was 3.785(AUC:0.731, Sensitivity:68.3%, Specificity:67%). A negative correlation was identified between albumin levels and lactate, C- reactive protein (CRP), and Blood urea nitrogen (BUN) levels across all patients. Conversely, a positive correlation was observed between neutrophil, lymphocyte, platelet, hemoglobin, sodium, and glucose levels. However, in patients with a cut-off point of 3.785 for albumin levels, a negative correlation was observed between albumin and lactate, CRP, and creatine levels. Conversely, a positive correlation was found between bicarbonate, platelet, hemoglobin, and glucose levels. Based on these findings, we conclude that hypoalbuminemia is associated with a higher rate of inotrope therapy and mechanical ventilation support. Furthermore, the rates of plasmapheresis, continuous renal replacement therapy, and extracorporeal membrane oxygenation initiation were markedly reduced in patients with elevated albumin levels (p < 0.001).ConclusionThe serum albumin, which is an excellent and cost-effective biomarker that can be readily and economically evaluated in any center worldwide, as evidenced by the findings of our study, is a highly efficacious indicator of admission albumin levels for the prediction of mortality and outcomes in PICUs. Furthermore, it predicts the selection of appropriate treatment and mechanical supports. It is straightforward to utilise, as it does not necessitate the use of scoring systems or tests that require lengthy and intricate analyses, and it is readily available.

Screening for Hypophosphatasia in Adult Patients at a Maximum Care Provider-Retrospective Analyses over Fifteen Years.

Background/Objectives: Hypophosphatasemia (HPE) may be temporary (tHPE) in the context of severe diseases, such as sepsis or trauma, or it may persist (pHPE), indicating an adult form of hypophosphatasia (HPP; OMIM 171760), a rare metabolic bone disorder caused by pathogenic nucleotide variants (PNVs) in the ALPLgene. The aim of this study was to analyze the role of auxiliary general biomarkers in verifying low alkaline phosphatase (ALP) serum activity level as an alert parameter for PNVs in the ALPLgene, which are indicative of HPP. In this retrospective analysis, we examined adult patients with an ALP serum activity level below 21 U/L. The cohort comprised 88 patients with temporary HPE (tHPE group) and 20 patients with persistent HPE who underwent re-examination. Genetic analysis performed on 12 pHPE patients identified PNV in the ALPLgene in 11 cases (ALPL group). Hemoglobin [HB], aspartate aminotransferase [AST], gamma-glutamyl transferase [GGT], calcium, phosphate, thyrotropin [TSH], albumin, total protein, and C-reactive protein [CRP] levels represented basic biomarkers. A comparative analysis between groups employed a Student's t-test, and a Student's t-test with bootstrap sampling (n = 10.000) was performed. Results: The mean HB, ALP, calcium, albumin, and total protein levels were lower in the tHPE group compared with the ALPL group (p < 0.01). AST and CRP were increased in the tHPE group (p < 0.01). The model showed an accuracy of 90% and an AUC of 0.94, which means that it can discern the two groups ~94% of the time. Conclusions: Basic biomarker evaluation effectively supports the interpretation of a decreased ALP serum activity level in the context of suspected HPP. In patients with laboratory HPE and biomarkers within reference, a PNV in the ALPLgene is highly suspected.

Metabolic and bariatric surgery in vegetarians and vegans.

Vegetarianism is constantly increasing worldwide. However, the role of metabolic and bariatric surgery (MBS) in vegetarians/vegans is unclear as there is very limited data on this topic. The aim of this study was to evaluate MBS outcomes in vegetarians or vegans. Retrospective analysis of a prospectively maintained database of a single-bariatric surgeon was carried out. All patients with a vegetarian or vegan lifestyle undergoing MBS were included. Eleven patients were included; none were lost to follow-up. Ten patients were women, the mean age and Body Mass Index (BMI) were 40.8±14 years and 43.5±4.9 kg/m2, respectively. Five patients (45%) were lacto-ovo-vegetarians, one (9%) was ovo-vegetarian, two (18%) were lacto-ovo-pesco-vegetarians, and three (27%) were vegans. Eight patients consumed vitamin supplements preoperatively, the mean albumin level was 4.1±0.2, 3/11 patients had vitamin D deficiency, 2/11 patients had vitamin-B12 deficiency, and 2/11 patients had iron deficiency. Eight patients (73%) underwent one anastomosis gastric bypass (OAGB), 2/11 patients (18%) underwent single anastomosis duodeno-ileal bypass with sleeve gastrectomy, and one patient (9%) underwent sleeve gastrectomy, the mean biliopancreatic limb length in OAGB was 225 cm. The median follow-up time was 17 months, the mean BMI and percentage of total weight loss during follow-up were 28.2±5 kg/m2 and 35.3±10.7%, respectively. The mean albumin level was 3.82±0.27, 3/11 patients had vitamin D deficiency, and 3/11 patients had iron deficiency. This study reports preliminary data on MBS outcomes in vegetarian/vegan patients. It was shown to be safe, effective, and an acceptable rate of nutritional deficiencies during follow-up. Further large cohort studies are required to clarify this data.

The Association Between Hypoalbuminemia and Catheter-Related Infections in Hemodialysis Patients

Background: Catheter-related infections cause significant complications in patients with end-stage kidney disease (ESKD) undergoing hemodialysis (HD). Objectives: This study aimed to evaluate the association between serum albumin level and catheter-related infection in HD patients. Methods: This study included 210 HD patients with positive blood and catheter cultures and 210 without catheter infection. Mean albumin level, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were also checked as surrogate disease markers and compared between the two groups. Results: Staphylococcus aureus (38.6% of cases) and Staphylococcus epidermidis (27.6% of cases) were the most frequently detected bacteria. Erythrocyte sedimentation rate and CRP were significantly higher in the target group (P = 0.002 and P = 0.001, respectively). Conclusions: In this investigation, hypoalbuminemia did not emerge as an independent risk factor for access-related infections. S. aureus and S. epidermidis were the predominant bacteria responsible for catheter-related infections in HD patients.

205. MINIMALLY INVASIVE IVOR LEWIS ESOPHAGECTOMY WITH TOTAL MEDIASTINAL LYMPHADENECTOMY FOR THORACIC ESOPHAGEAL CANCER: SHORT- AND LONG-TERM OUTCOMES IN 139 PATIENTS

Abstract Background The McKeown approach is a standard surgery for thoracic esophageal cancer in Japan, as lymph node dissection of upper mediastinum and neck is mandatory. The thoracoscopic approach allows access to the lymph node chain along the laryngeal nerves from the chest and led us to introduce minimally invasive Ivor Lewis esophagectomy (MIILE) with radical lymphadenectomy for middle and lower esophageal cancer. Although circular-stapled anastomosis is popular in MIILE, the frequency of anastomotic complications has been reported to be high. We introduced MIILE with linear-stapled anastomosis in 2010. Methods To evaluate the short- and long-term outcomes of MIILE with radial lymphadenectomy and linear stapled anastomosis, we performed a retrospective cohort study of 139 consecutive patients. The endpoints included overall complications, anastomotic leak rate, nutritional status at 12 months after MIILE, and 5-year overall survival, and disease-free survival. Surgical Procedure After laparoscopic gastric tube construction, thoracoscopic or robotic esophagectomy with total mediastinal lymphadenectomy was done in the prone position. ICG angiography was used to assess gastric tube viability and sacrifice the ischemic portion in recent cases. Esophago-gastric anastomosis was performed using a linear stapler. The opening was closed with interrupted sutures and covered with the omentum to secure the anastomosis. Results There was 122 male and 17 female patients with median age of 69 years. Preoperative diagnosis was stage I/II/III/IV in 44/46/37/12 patients. Pathology results were SCC in 108 cases. Tumor location was middle/lower/EGJ in 58/64/17 patients. Preoperative chemotherapy or CRT was administered in 77 patients. Median thoracic surgery time was 297 minutes and blood loss was 53 mL. Median hospital stay was 17 days. The short-term complication rate of grade IIIa or higher was 8.7%. Anastomotic leak occurred in 8 patients (5.8%), three of whom required intervention. No leakage occurred after introduction of intraoperative ICG angiography. 90-day mortality was 0.7%. With a median follow-up of 41 months, 5-year overall survival rate was 68.3% and disease-free survival rates was 56.7%. For the 65 SCC patients with clinical stage II/III disease, 5-year OS rate was 58.7%. During follow-up period, 2 patients (1.4%) required balloon dilatation due to anastomotic stenosis. At 12 months after MIILE, the mean weight loss was 11.6% and the mean albumin level was 3.9. Discussion Compared to benchmark complication rates reported by the international Esophagectomy Complication Consensus Group (ECCG), the overall complication rate (47% vs. 59%) was not significantly lower, but the anastomotic leak rate was significantly lower (5.8 vs. 11.4%). Overall survival, disease-free survival, and nutritional outcomes were similar to those reported in Japanese clinical trials. Conclusions MIILE with linear-stapled anastomosis is a safe procedure with a low rate of serious complications. Survival and nutritional outcomes were excellent. It may be recommended as a standard procedure for lower and middle esophageal cancer. https://www.dropbox.com/scl/fi/z6zyllnmie9qh3zhz2wd5/Okabe_ISDE.wmv?rlkey=4mig28fv5z2vhaui31tbk0mr9&amp;dl=0

Screening for undernutrition in gastric bypass: a case study of four patients in the Marrakech Tensift Al Haouz region, Morocco

Undernutrition presents a major risk to patients’ health and well-being following gastric bypass surgery. After undergoing this surgery, the nutritional status of three women and one man was examined in this study. Follow-up visits were used to measure weight, body composition, and biological and biochemical data. After 3 months of follow-up after gastric bypass surgery, our findings revealed a reduction in muscle mass. The average loss of muscle mass was 4.375±1.470 kg. Their initial body mass index, which was 45.01 kg/m2, on average, dropped to 28.38 kg/m2. Significant drops were observed in the mean levels of albumin and pre-albumin (albumin: 38.6 g/L to 24.8 g/L, pre-albumin: 195 mg/L to 113 mg/L). In our study, patients with micronutritional deficiencies and gastric bypass demonstrated a significant and adaptive reduction in daily caloric intake. Early identification of undernutrition makes it possible to assess its severity and, as part of the patient’s overall follow-up, to implement appropriate nutritional management.

Preoperative level of serum transthyretin as a novel biomarker predicting survival in resected pancreatic ductal adenocarcinoma with neoadjuvant therapy

BackgroundSystemic inflammation and altered metabolism are essential hallmarks of cancer. We hypothesized that the rapid turnover protein transthyretin (TTR) (half-life: 2–3 days), compared with the conventional marker albumin (21 days), better reflects the inflammatory/metabolic dynamics of pancreatic ductal adenocarcinoma (PDAC) after neoadjuvant therapy (NAT) and is a useful prognostic marker. MethodsSerum TTR and albumin levels were measured in 104 consecutive post-NAT PDAC patients before curative resection. The associations of preoperative TTR and albumin levels with overall survival (OS) after pancreatectomy were retrospectively analyzed. ResultsThe mean (SD) TTR and albumin levels were 21.6 (6.4) mg/dL (normal range: ≥22.0 mg/dL) and 3.9 (0.55) g/dL. A low (<22.0 mg/dL) post-NAT TTR level was associated with an advanced tumor stage and higher CEA and CRP levels. Patients with low TTR levels showed significantly worse OS compared with normal levels (3-year OS 39 % vs. 54 %, P = 0.037), although albumin levels did not. We modified prognostic biomarkers of systemic inflammation/metabolism, such as GPS, PNI, and CONUT scores, using the serum TTR instead of albumin level and successfully showed that modified scores were better associated with OS compared with original scores using serum albumin level. ConclusionsOur data suggest that the TTR level is a promising prognostic biomarker for PDAC patients after NAT.

The Effect of Nutritional Status in the Treatment of Periprosthetic Joint Infections in Total Hip Arthroplasty

BackgroundPeriprosthetic joint infections (PJIs) continue to be a complication that plagues arthroplasty. Albumin is a surrogate marker for nutrition as well as chronic inflammation, and hypoalbuminemia increases the risk of complications in arthroplasty. Patients with PJI are at increased risk for malnutrition and complications. This study’s objective was to analyze patients who underwent treatment of PJI following total hip arthroplasty and investigate the outcome with regards to albumin levels. MethodsOverall, 48 patients who underwent surgery for a total hip PJI at 1 institution were reviewed. Albumin and C-reactive protein were recorded preoperatively and 2 to 3 weeks postoperatively. Treatment failure was determined by further surgical treatment for PJI or repeat infection, as determined by Musculoskeletal Infection Society guidelines. ResultsA debridement, antibiotics, and implant retention procedure was performed in 39 patients, and explant with the placement of an antibiotic spacer was performed in 9. Preoperative mean albumin levels were significantly decreased in patients who failed to clear their infection compared to patients who remained infection-free (2.5 versus 3.3, P < .001). Postoperative albumin levels decreased in this same population (2.6 versus 3.8, P < .001). C-reactive protein was elevated in patients who failed to clear their infection preoperatively (19.9 versus 7.5, P < .001) and postoperatively (7.0 versus 1.7, P < .001). The average time to repeat surgical treatment for their PJI was 9 months ConclusionsLower albumin levels are observed in patients with PJI who failed to remain infection-free after surgery. Albumin is a surrogate marker for nutrition, and low albumin is associated with poor immune function. Hypoalbuminemia is found with chronic inflammation as well as malnutrition. Nutritional reserves are diverted to the acute inflammatory response during an infection, which can lead to a deficient state. Further research may develop treatments to alter this modifiable risk factor. Level of EvidenceLevel 4.

Health Technology Assessment of Cardiopulmonary Bypass Circuit with and without Phosphorylcholine Coating: A Retrospective Study on Safety and Efficiency in Cardiac Surgery.

Phosphorylcholine has emerged as a potential adjunctive agent in cardiopulmonary bypass (CPB) circuits. Phosphorylcholine serves as a coating for the CPB circuit, potentially enhancing biocompatibility and reducing thrombotic events. However, its impact on specific patient populations and procedural outcomes remains underexplored. In this retrospective study, we analyzed data from 60 patients who underwent cardiac surgery with CPB, comprising 20 cases each of coronary artery bypass grafting (CABG), mitral valve repair, and aortic valve replacement. The patient cohort was divided into two groups-30 patients whose CPB circuits were coated with phosphorylcholine (phosphorylcholine-coated group) and 30 patients who did not receive phosphorylcholine supplementation or circuit coating. Both groups underwent surgery with identical CPB circuit designs. We assessed the absence of adverse events, safety, and efficacy parameters, including blood loss, clotting, and the structural integrity of the CPB circuit. Additionally, we measured changes in mean albumin levels (g/dL), mean platelet counts (×109/L), and antithrombin III (ATIII) levels before and after CPB. The retrospective analysis revealed an absence of adverse events in both groups. In the phosphorylcholine-coated group compared to the non-phosphorylcholine-coated group, there was a notable difference in the delta change in mean albumin levels (0.87 ± 0.1 vs. 1.65 ± 0.2 g/dL, p-value 0.021), mean platelet counts (42.251 ± 0.121 vs. 54.21 ± 0.194 × 109/L, p-value 0.049), and ATIII levels (16.85 ± 0.2 vs. 31.21 ± 0.3 p-value 0.017). There was a notable reduction in the perioperative consumption of human complex units after CPB (3 vs. 12, p-value 0.019). Both groups, phosphorylcholine and non-phosphorylcholine, demonstrated the absence of adverse events and that the systems are safe for iatrogenic complication. Our findings suggest that the use of phosphorylcholine coating on the CPB circuit, in the absence of supplementary phosphorylcholine, in cardiac surgery is associated with favorable changes in mean albumin levels, mean platelet counts, and ATIII levels. Further research is warranted to elucidate the full extent of phosphorylcholine's impact on patient outcomes and CPB circuit performance.

Predictors of poor response to immune-checkpoint inhibitor (ICI) treatment among patient with hepatocellular carcinoma (HCC).

e16212 Background: No established risk factors or toxicity biomarkers exist for HCCs treated with ICI, even though they are commonly used in clinical practice. The outcomes in real-world practice are worse than those reported in clinical trials. This retrospective review aims to identify HCC patients at high risk of failing ICI therapy. Methods: HCC patients who received at least one ICI dose between 1/1/2017 and 5/30/2023 (before tremelimumab/durvalumab approval) at the Ohio State University were included in this study. The patient's baseline (BL) characteristics (at the first dose of ICI) were extracted with immune-related adverse event (irAE) details and survival outcomes. We examined BL characteristics significantly different in poor (progression-free survival (PFS) ≤ median (m)) and worst (PFS ≤ 25% percentile) responders, and poor (overall survival (OS) ≤ m) and worst (OS ≤ 25% percentile) survivors. Chi-square test and logistic regression were performed using JMP Pro 17 (SAS Institute Inc., Cary, NC). Results: Our cohort included 53 HCC patients. The median age was 66 years (range 40-86), with 81% male and 85% White (13% African American and 2% other). The median OS and PFS were 19 months (m) (95% confidence interval [CI], 8-26) and 5m (95% CI, 2-9), respectively. The poor responders (PFS ≤5m, N = 30) had patients with significantly higher alcohol history (AHx, 90% vs. 70%) and mean alpha-fetoprotein (AFP, 44, 155 vs. 811 ng/mL) levels, a higher proportion of Child-Pugh (CP) C (A/B/C %, 53/27/20 vs. 53/47/0), and negligible bevacizumab (bev, 77 vs. 24) use, all (p &lt; 0.05). The worst response group (PFS ≤2m, N = 16), furthermore, had significantly (p &lt; 0.05) higher Albumin-bilirubin (ALBI) grade (G) 3 patients (50% vs. 16%), higher mean total bilirubin (2 vs. 1,2 ng/mL), lower tyrosine-kinase inhibitor (TKI, 7% vs. 46%), and lower mean albumin (Ab, 3 vs. 3.4) levels. A significantly (p &lt; 0.05) higher fraction (fx) of poor survivors (OS ≤19m, N = 33) got ICI In the first or second line (85% vs. 45%) and did not receive any locoregional therapy (LRT, 66% vs. 35%). The worst survivors (OS ≤8m, N = 14) got ICI in the first line (100% vs. 59%, p = 0.04, and significantly (p &lt; 0.05) lower Alb (3 vs. 3,4) and higher AFP (90620 vs. 3104) levels. The irAE group (N = 10, 19%) had higher AFP (115289 vs. 3482, p = 0.01) and a lower distant metastasis rate (20% vs. 58%, p = 0.02), and none of them received bev (0% vs. 30, p = 0.04). Conclusions: Response to ICI depends on BL liver function (AHx, ALBI, CP, Alb) and combination therapy (bev). Survival depends on HCC management up to the administration of ICI (LRT and TKI).

The Effect of Egg White Meal on Anemia in Patients on Hemodialysis Taking Erythropoietin and Iron Infusion.

Eggs are a useful and cheap food source. We evaluated the effects of egg white meal on anemia in dialysis patients. In an open-label, clinical trial, conducted in dialysis centers, 107 hemodialysis patients aged ≥18 years with hemoglobin levels below 12 g/dL and requiring treatment with artificial erythropoietin and iron infusion were included in the study. They were divided into a control and an intervention group. The participants in the intervention group consumed an egg white pack (containing six egg whites, 96 calories, 24 g protein) as a substitute for meat products 3 days a week for 8 weeks. Finally, changes in serum albumin, hemoglobin, ferritin and iron/TIBC, erythropoietin dose and iron infusion dose were measured. A total of 107 dialysis patients were studied, (55 patients in egg white and 52 in control groups) with the mean age of 54.31±16.35 years and male majority (57.90%). The mean of hemoglobin concentration had no statistically significant difference at baseline (P=0.13) and after four weeks. (P=0.48), while after eight weeks, the mean hemoglobin concentration in the intervention group was significantly higher than the control group. (P=0.03) mean of synthetic erythropoietin dose after 4 and 8 weeks was significantly lower in the intervention group compared to the control group. (P=0.30, P=0.001) lower ERI values in intervention group was significantly higher than the control group. (P=0.02) CONCLUSION: We observed that consumption of egg whites led to an increase in mean hemoglobin concentration, serum iron, and albumin levels. These results suggest that egg whites could be a useful dietary intervention for dialysis patients with anemia.

Correlation Of Albumin Levels With Glucose Levels in Hypoglycemic Patients After The Use Of Insulin Therapy

Background: Most of the incidence of hypoglycemia in hospital (11.29%) is caused by administering insulin therapy as a therapeutic modality in diabetes mellitus patients during hospitalization. The bond between albumin and insulin using the help of fatty acids makes insulin control the body's glycemic levels. Aim: The purpose of this study was to determine and analyze the correlation between albumin levels and glucose levels in hypoglycemia patients after the administration of insulin therapy at the Ratu Zalecha General Hospital. Methods: This study was an analytic observational study with a cross-sectional approach. A total of 32 samples were obtained by purposive sampling Results: The patient's mean glucose level was 48.95 ± 11.5 mg/dL and the patient's mean albumin level was 2.4 ± 0.6 g/dL. Bivariate analysis using Pearson's correlation test showed a correlation between albumin levels and glucose levels (p = 0.045 &lt;0.05; r = 0.356). Conclusion: The conclusion is that there is a significant correlation between albumin levels and blood glucose levels, the direction of the positive correlation with the strength of the weak correlation in the endocrine internal medicine ward of the Ratu Zalecha Martapura Hospital.

LEVEL OF ALBUMIN IN MALARIA AND HIV CO INFECTED PREGNANT WOMEN, ATTENDING THE ANTENATAL CLINIC OF NNAMDI AZIKIWE UNIVERSITY TEACHING HOSPITAL, NNEWI, SOUTH EASTERN NIGERIA

The purpose of the study was to measure the amount of albumin in pregnant HIV-positive malaria-infected women. Participants in the study were 18 to 40 (36.98 + 5.49) years old, HIV stage 1 and 2 seropositive pregnant women. 80 HIV-positive pregnant women with 40 co-infected with malaria and 80 HIV-negative pregnant women with 40 coinfected with malaria comprised the participant groups. Blood samples were obtained from the subjects for malaria parasite identification using the thick and thin film methods, and HIV status determination using the immunochromatographic approach. The bromocresol green albumin binding method was used to measure the amount of albumin, and the resultant solution was measured spectrophotometrically at 628 nm. In all cases, there was a statistically significant difference in albumin levels between the HIV seronegative group with and without malaria infection (p&lt;0.05) and HIV seropositive group with malaria infection. The mean albumin level of HIV-positive pregnant women who have malaria infection was statistically higher than that of HIV-positive pregnant women who do not have malaria but statistically lower than those of HIV-negative pregnant women with and without malaria infection. The study suggests that pregnant HIV-positive women do not experience a decrease in albumin levels because of malaria infection.

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

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

The Impact of Serum Albumin on the Mortality Prediction in COVID Patients at a Private Hospital in Madurai

Abstract Background: The objective of the study was to identify the serum albumin levels and their correlation with the length of hospital stay and mortality in coronavirus disease 2019 (COVID-19) patients. To achieve this, we studied the correlation between serum albumin levels to the length of hospital stay and mortality outcomes. Materials and Methods: It is a retrospective observational study in which information about COVID-19 patients admitted to a private hospital in Madurai was collected between March 2021 and August 2021. The time from admission to discharge of patients and mortality outcomes was taken into account. Results: A total of 176 COVID-19 patients were included, of which 150 patients (85%) recovered and 26 patients (15%) died during the hospital admission. The median length of hospital stays of COVID-19 patients who were hospitalized and discharged alive was found to be 8.5 ± 4.6 days by the Kaplan–Meier curve. The mean albumin levels in alive patients were found to be 3.5 ± 0.37 g/dl compared to expired COVID-19 patients with low albumin levels of 3.3 ± 043 g/dl. Hence, we conclude that serum albumin levels had an impact on the outcome and hospital stay. Conclusion: Serum albumin levels at admission might reflect the severity of infection and thus can serve as a predictive factor for COVID-19 outcomes.

Effects of smokeless nicotine on blood physiology, biochemical, and histological alterations using Labeo rohita as a model organism.

The present research was conducted to evaluate the negative effects of nicotine powder on the blood physiology, and biochemical and histological alterations of Labeo rohita. Fish were divided into four groups (1-4). Fish groups 2, 3, and 4 were exposed to different concentrations of nicotine, such as 0.75, 1.25, and 1.75 mg/l, while group 1 acted as a control. To find out the long-term impact of nicotine on body physiology, we conducted a 42-day experiment. After the completion of the experiment, hematology, biochemical assays, and histology were done. Results revealed a considerable increase in HGB, red blood cells, WBCs, hematocrit, mean corpuscular volume, red cell distribution width -SD, procalcitonin, neutrophils, lymphocytes, monocytes, triglycerides, total cholesterol, low-density lipoprotein, very low-density lipoprotein, alanine transaminase, aspartate aminotransferase, globulin, thyroid stimulating hormone, BUN, creatinine, and blood glucose levels, whereas mean corpuscular hemoglobin concentration, mean corpuscular hemoglobin, RDW, platelet, high-density lipoprotein, albumin, total proteins, and T3 levels were significantly (p ≤ 0.05) decreased in exposed fish as compared to control group fish. Histological alterations showed that exposure to smokeless nicotine causes deleterious and degenerative effects in the liver, kidney, and gills of exposed fish. Nicotine administration in fish results in adverse effects on different biochemical and hematological parameters and causes histological alterations in some vital organs of exposed fish.

Hematological abnormalities in chronic liver disease and their association with severity and types of chronic liver disease

This study aimed to assess the hematological abnormalities in CLD patients and to study the association of hematological abnormalities with type and severity of CLD. This study was conducted as a facility based cross-sectional study at tertiary care centre on confirmed cases of chronic liver disease. Detailed clinical history along with clinical examination findings were recorded. All patients were then subjected to investigations. Mean age of patients with CLD was 48.8±16.9 years and majority of patients were males (76%). Anemia was observed in 71% cases with CLD whereas leukocytopenia and thrombocytopenia were noted in 21% and 56% cases respectively. Mean MCV, MCH, serum bilirubin and iron were significantly higher in cases with alcoholic liver disease whereas TIBC was significantly lower in ALD cases as compared to NALD cases (p&amp;#60;0.05). Mean hemoglobin, platelet levels, MCV, albumin and iron levels were significantly lower in cases with severe liver disease (Child Pugh Class C). However, serum bilirubin, prothrombin time and TIBC levels increased significantly with increase in severity of CLD (p&amp;#60;0.05). Hematological abnormalities particularly normocytic normochromic anemia and thrombocytopenia are common in cases with CLD, which might affect the prognosis of patients with CLD. Assessing the severity and type of anaemia is a useful tool for early initiation of the treatment in patients of CLD for reducing the morbidity and mortality. Early detection and treatment of haematological changes can prevent complications and reduce the mortality in CLD patients.

Multiple cardiometabolic diseases enhance the adverse effects of hypoalbuminemia on mortality among centenarians in China: a cohort study

BackgroundAlthough hypoalbuminemia was associated with high risk of mortality in community-dwelling older adults, as well as in the hospitalized older adults, little is known among centenarians. And there are limited data on whether having cardiometabolic diseases (CMDs) is associated with additive effects.MethodsBaseline examinations including a determination of albumin levels were performed in 1002 Chinese centenarians from January 2014 through to December 2016, and the survival status was subsequently ascertained until 31 May 2021. Cox proportional risk model was performed to assess the risk of all-cause mortality associated with albumin levels and hypoalbuminemia combined with CMDs.ResultsOf 1002 participants included in the analysis, the mean level of albumin was 38.5 g/L (± standard deviation, 4.0 g/L), and 174 (17.4%) had hypoalbuminemia (albumin < 35 g/L). The multivariable analyses showed that albumin level was negatively associated with all-cause mortality (Ptrend < 0.05). Compared to normoalbuminemia, hypoalbuminemia was associated with an increased mortality risk in the overall participants (hazard ratio [HR]: 1.55, 95% confidence interval [CI]: 1.22–1.97). Furthermore, the HR (95% CI) of hypoalbuminemia combined with multiple CMDs was 2.15 (1.14–4.07). There was evidence of an additive deleterious dose effect of an increasing number of CMDs (Ptrend = 0.001).ConclusionsHypoalbuminemia is associated with an increased risk of all-cause mortality in Chinese centenarians, and this risk is more pronounced among centenarians with multiple cardiometabolic diseases. Our findings suggest that older adults with hypoalbuminemia, especially comorbid multiple CMDs warrant early identification and management.