Mean Serum Albumin Levels Research Articles

Constipation and upper gastrointestinal bleed: Leading precipitating factors of hepatic encephalopathy in Indian cirrhotic patients

Abstract Background Liver cirrhosis and its complications pose major health problems. In India, commonest causes of cirrhosis are alcohol abuse and viral hepatitis. Hepatic encephalopathy (HE) is a life-threatening complication of cirrhosis. This study aimed to determine clinical, etiological and laboratory profile of chronic liver disease patients presenting with HE. Methods Cross-sectional study was conducted in Institute of Internal Medicine at Madras Medical College, Chennai. Seventy-five diagnosed cases of chronic liver disease presenting with hepatic encephalopathy were enrolled. Hepatic encephalopathy was clinically graded according to West Haven grading. Results Middle aged group males comprised the largest affected group (30–50 year). Alcohol abuse was most common etiological factor. Jaundice (78%) was most common presenting complaint. Most common precipitating factors were constipation (54%) and upper gastrointestinal (GI) bleeding (45%). Thrombocytopenia was present in 78% cases while 16% cases presented with coagulopathy. The mean serum AST, ALT, bilirubin, ALP and albumin level were 90 U/l, 68.4 U/l, 9.66 mg/dl, 124.2U/l and 2.9 g m/dl, respectively. Mean serum urea and creatinine level were 43.22 mg/dl and 1.39 mg/dl respectively. Conclusion In the specific study group, alcohol-related chronic liver disease was the commonest, with constipation and upper gastrointestinal bleeding being the leading precipitating factors for hepatic encephalopathy.

Anatomic Recanalization of Hepatic Vein and Inferior Vena Cava versus Direct Intrahepatic Portosystemic Shunt Creation in Budd-Chiari Syndrome: Overall Outcome and Midterm Transplant-Free Survival

PurposeTo assess overall outcome and midterm transplant-free survival of patients with Budd-Chiari syndrome (BCS) undergoing radiologic interventions including anatomic recanalization of the hepatic vein (HV) and inferior vena cava (IVC) and direct intrahepatic portosystemic shunt (DIPS) creation, both as combined and as independent groups. Materials and MethodsFrom November 2010 to October 2014, 136 patients with BCS were treated with HV/IVC recanalization (group 1) or DIPS creation (group 2). Both groups were periodically analyzed for stent patency on Doppler ultrasound, clinical outcome, biochemical parameters, and survival until death, liver transplantation, or last clinical evaluation. ResultsActuarial transplant-free survival for the entire cohort was 94% at 1 year and 5 years with no significant difference in overall survival. There was significant biochemical improvement in group 1 with decrease in mean serum bilirubin level (1.8 mg/dL to 1.4 mg/dL, P < .011), mean serum aspartate aminotransferase (48.6 IU/L to 33.2 IU/L, P < .05), and mean serum alanine aminotransferase (38.7 IU/L to 28.5 IU/L) and increase in mean serum albumin level (3.2 g/dL to 3.45 g/dL, P < .001) after 3 and 24 months. There were 4 deaths in each group at 1-year follow-up; all 4 patients had acute fulminant BCS at presentation. ConclusionsRadiologic interventions for BCS lead to remarkable improvement of liver function and a good overall outcome and midterm transplant-free survival. Patients receiving anatomic recanalization show improved liver synthetic functions compared with patients treated with DIPS.

Young Investigator: Hypoalbuminemia as Risk Factor for Thromboembolic Events in Hospitalized Inflammatory Bowel Disease Patients: An Observational and Retrospective Analysis

BACKGROUND: Inflammatory bowel diseases (IBD) are chronic entities characterized by local and systemic inflammation that predominantly affects the gastrointestinal tract and may be associated with numerous extraintestinal manifestations including thrombosis. The association between IBD and thromboembolic events (TEE) was first described in 1936 in a study involving more than 1000 patients with IBD followed at the Mayo Clinic. TEE were found in 1.2% of the cases. Since then, several studies have demonstrated such association. The incidence of TEE in patients with IBD ranges from 1.2-6.7%, increasing to 39% in post mortem. Such events occur mostly at a time when IBD is active and (or) with complications such as stenosis, fistulas and abscesses. The aim of this study was to identify the prevalence of TEE in hospitalized IBD patients and find risk factors for its occurrence. METHODS: This was a retrospective single-center longitudinal study carried out by reviewing the medical records of patients with IBD from the gastroenterology and colorectal surgery units at the University of Campinas, Brazil, between 2004 and 2014. Patients hospitalized for more than 48 hours, due to active IBD and who did not use prophylaxis for TEE during hospitalization, were included. Patients with hematopoietic systemic diseases or with coagulopathies, using anticoagulant medications up to 30 days before admission and pregnant women were excluded. Patients were allocated in two groups: those with TEE up to 30 days or at the time of hospitalization (TEE-group) and patients without TEE (control-group). Clinical characteristics (disease duration, medical therapy, extra-intestinal manifestations, disease activity) and laboratorial characteristics (complete blood count, CRP, ESR, albumin, pre albumin, coagulogram) of the patients were evaluated. RESULTS: 45 patients, 23 (51.1%) female were evaluated. 32 patients (71.1%) had Crohn's disease (CD) and 13 (28.9%) ulcerative colitis (UC). At the time of admission, 24.4% of the patients were off treatment due to the recent diagnosis. Only 4.4% of the patients were active smokers and 8.9% were previous smokers. 56.5% of the women used hormonal contraceptive methods. The mean biochemical factors related to the nutritional aspect (albumin and pre-albumin) were reduced (albumin: 3.07±0.94g/dL, pre-albumin: 16.79±10.8mg/dL). Both mean serum albumin and pre-albumin levels were lower in CD (albumin: 2.9±0.93g/dL, pre-albumin: 12.37±8.9mg/dL). The prevalence of TEE, 30 days before or during hospitalization, was 17.7%(n=8), 12.5% in CD and 30.7% in UC. There was no difference between the gender. Patients with TEE presented depletion of the anthropometric status, BMI= 17.6±3.26Kg/m2 in relation to the control group 23.2±3.7Kg/m2. In TEE group, mean serum albumin was 2.06±0.62g/dL vs 3.3±0.85g/dL in the control group. In univariate analysis, only hypoalbuminemia was considered a risk factor for TEE. Individuals with hypoalbuminemia (values below 2.62g/dL) had a 14.8 fold higher chance of developing any TEE (P<0.001). CONCLUSION(S): TEE were identified in 17.7% of admitted IBD patients. Albumin levels were significantly lower in individuals with TEE. Hypoalbuminemia was a risk factor for the development of TEE in IBD. Serum albumin dosage is a simple and accessible test that can be used in the risk stratification of active IBD patients.

Hypoalbuminemia as a marker of adverse outcome in children admitted to pediatric intensive care unit

Background: Research on critically ill adult patients has shown the usefulness of albumin as a predictor of increased morbidity and mortality. There is a paucity of similar data in pediatric age group. Objective: The objective of the study was to know the incidence of hypoalbuminemia in children admitted to pediatric intensive care unit (PICU) and its correlation to disease severity and clinical outcome. Materials and Methods: This was a prospective observational study conducted at the PICU of a tertiary care hospital. Children of age group 1 month – 18 years admitted to the PICU were included in the study. Serum albumin levels were estimated at the time of admission to PICU. Pediatric index of mortality 2 (PIM2) scoring system was used to assess the severity of illness at admission and to calculate the predicted death rate (PDR). The independent sample t-test and Fisher’s exact test were used to compare the albumin levels with PDR and duration of hospital or PICU stay. Mortality risk was computed using Pearson’s Chi-square test. Multivariate regression analysis was performed to evaluate whether hypoalbuminemia is an independent predictor of mortality. Results: Mean serum albumin level in this study was 3.38±0.89 g/dL. The incidence of hypoalbuminemia was 44.1%. The PDR (calculated using PIM2 score) was increased in children with hypoalbuminemia compared with the normal albumin level group (p=0.004). As compared to children with normal albumin levels, children with hypoalbuminemia had longer duration of PICU stay (95% confidence interval (CI) for difference 0.86–3.03; p=0.05), higher need for ventilator support (odds ratio (OR) 4.2, p=0.003) and higher mortality (OR 0.16, p=0.002). The association of serum albumin levels with mortality remained significant even after adjusting for age and PDR by PIM2 score (OR=3.68; 95% CI, 1.76–7.74; p&lt;0.001). Conclusion: Hypoalbuminemia is a significant predictor of mortality and morbidity in critically ill children.

Nutritional therapy and effect assessment of infants with primary intestinal lymphangiectasia: Case reports.

Rationale:Intestinal lymphangiectasia (IL) is a rare enteropathy involving the expansion and rupture of intestinal lymphatic channels. Although several reports have studied cases of primary IL (PIL), this condition is very rare, and is even less commonly encountered in infants. This study aimed to investigate the nutritional therapy and effect assessment of chylous reflux disorder caused by PIL in infants.Patient concerns:Infantile patients were enrolled in the Affiliated Beijing Shijitan Hospital of the Capital Medical University between January 2012 and March 2014. The minimum age of onset was 4 months and the maximum age of onset was 16 months, with an average age of 4.9 months.Diagnoses:All children were inpatient who had been diagnosed with chylous reflux syndrome (chylothorax and/or chylic abdomen) caused by PIL.Interventions:Retrospective analysis and individualized nutrition therapy of these cases were carried out. Finally, nutritional therapy and prognosis of PIL were assessed and summarized.Outcomes:All the children survived, showed improvement in the serum total protein, albumin, and HGB levels after nutritional therapy. After comprehensive nutritional therapy, we were able to achieve diarrhea control for all the 9 patients, and after treatment, the children passed soft, yellow stools 1 to 2 times/d. After treatment, the height and weight of all patients increased to within the normal ranges of the World Health Organization standard chart. The mean serum albumin level reached 41.3 g/L. All nutrition-related indicators were found to have significant improvement compared with the baseline levels.Lessons:The results revealed that nutritional therapy for the 9 children with PIL was effective, and it may be able to improve the clinical syndromes and symptoms of children with PIL and promote recovery.

Obesity and morbid obesity associated with higher odds of hypoalbuminemia in adults without liver disease or renal failure.

Background and objectiveStudies are needed in order to inform recommendations for interpreting albumin levels among obese individuals without known medical conditions associated with hypoalbuminemia. The objective of this study was to examine the association of obese and morbidly obese status with hypoalbuminemia, while adjusting for age, sex, diabetes, prediabetes, diabetic nephropathy, and nephrotic syndrome.Patients and methodsRetrospective data collection from adult patients presenting to the outpatient Endocrinology and Metabolism Clinic was performed between January 2015 and December 2015. An initial sample of 180 patients was selected. After excluding patients who were younger than 18 years, who had known cases of liver disease or renal failure, or who had missing data, a final sample of 122 subjects was identified. Serum albumin and objectively measured weight and height data were retrieved from hospital records. A board-certified endocrinologist reviewed patient records to identify the presence of renal and diabetic conditions. Descriptive statistics were used to examine sample characteristics. Multiple logistic regression analysis was used to examine the association of obesity and morbid obesity with hypoalbuminemia (serum albumin < 34 g/L) while adjusting for age, sex, diabetes, prediabetes, diabetic nephropathy, and nephrotic syndrome.ResultsApproximately 43% of the sample were categorized as obese and 13% were categorized as morbidly obese. The mean serum albumin level was 38.00 g/L (standard deviation [SD] = 4.26) among subjects who were neither overweight nor obese, 38.35 g/L (SD = 0.48) among overweight subjects, 34.57 g/L (SD = 4.71) among obese subjects, and 33.81 g/L (SD = 3.71) among morbidly obese subjects. Adjusting for age, sex, diabetes, prediabetes, nephrotic syndrome, and diabetic nephropathy, obese subjects had significantly higher odds of hypoalbuminemia (odds ratio [OR]: 4.10, 95% confidence interval [CI]: 1.50–11.27, P-value = 0.006), as did morbidly obese subjects (OR: 6.94, 95% CI: 1.91–25.23, P-value = 0.003).ConclusionThe findings suggest that obesity and morbid obesity can be considered as independent predictors of hypoalbuminemia. The findings can be used to inform future studies aiming to better understand the association of obesity and morbid obesity with hypoalbuminemia and to help inform guidelines for clinicians on how to correctly interpret and utilize serum albumin data for obese individuals.

Nutritional Status as an Adjunct Risk Factor for Early Postoperative Complications Following Posterior Cervical Fusion.

Retrospective study on prospectively collected data. The aim of this study was to study the impact of nutritional status, as measured by serum albumin level, on patient outcomes following posterior cervical fusion (PCF) surgery. Malnutrition is a potential modifiable risk factor that has garnered an increasing amount of attention within orthopedics in recent years. There is evidence to suggest the role of nutritional status in lumbar and ACDF surgery, yet the data for PCF are still lacking. The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) was queried by current procedure terminology (CPT) from 2010 to 2014. Bivariate analyses were performed to compare the preoperative characteristics between those with normal albumin and hypoalbuminemia. Postoperative complications and outcomes were similarly analyzed for those with and without low albumin levels. Stepwise multivariate logistic regression models were employed to determine whether hypoalbuminemia was an independent risk factor for short-term patient outcomes and complications. There were 1573 cases with measured albumin levels (42.4%). The mean (standard deviation) serum albumin level was 3.9 (0.6). Among these patients, 265 (16.8%) cases had hypoalbuminemia. The adjusted analyses demonstrated that patients with hypoalbuminemia had a significantly higher risk for length of stay >5 days (odds ratio [OR] = 3.8; 95% confidence interval [CI] = 2.8-5.1; P < 0.0001). In addition, hypoalbuminemia was an independent risk factor for any complications (OR = 2.7; 95% CI = 1.9-3.7; P < 0.0001), pulmonary complications (OR = 2.3; 95% CI = 1.2-4.5; P = 0.010), intra/postoperative blood transfusions (OR = 3.2; 95% CI = 2.1-4.9; P < 0.0001), sepsis (OR = 4.0; 95% CI = 1.7-9.2; P = 0.001), and venous thromboemoblism (OR = 3.6; 95% CI = 1.5-8.5; P = 0.004). These findings implicate that a baseline serum albumin <3.5 g/dL may serve as a valuable prognostic measure for the development of several complications following PCF surgery. 3.

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

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

Role of Zinc in patients with Nephrotic syndrome

Introduction: Nephrotic syndrome(NS) is one of the most common cause of chronicmorbidity in developing countries. This study is aimed to assess the effect of zincsupplementation in patients with NS and to evaluate its association with serum albuminlevel, relapse rate and infection frequency. Materials & method: In this randomized, double blind, placebo-controlled trial study, 60patients with NS, both with the first episode and first relapse, age between2-10 years were included. Among the 60 patients, 30 patients of NS getting zinc were inzinc group and 30 patients of nephrotic syndrome getting placebo were in placebogroup. Zinc status was assessed before and after giving zinc or placebo..Results; Serum zinc level has been found significantly lower during relapse (0.54±0.18and 0.56±0.22), it has increased during remission, which is (0.85±0.42) normal in zincgroup and remained low (0.69±0.14) in placebo group. The mean serum albumin levelduring relapse were low in both groups,14 days later it was increased but still low.The difference of mean percentage of increase of height after 6 months was notstatistically significant (3.3±1.2 % vs. 3.3±1.9 %) in two groups.19 patients (63.3%) in zinc group developed relapse compared to 15 patients (50%) in placebo group, the difference was not statistically significant. Infection had occurred 73.3% after zincsupplementation as compared with 63.3% in placebo group. Conclusion: When zinc was given in RDA for short duration doesn’t reduce relapsein NS and doesn’t significant increase zinc level compared to placebo.

Vitamin D Levels are Associated with Liver Disease Severity in Patients with Cirrhosis

Vitamin D deficiency is common in advanced liver disease but its clinical significance remains controversial. The aim of this study was to examine the correlation of 25-hydryoxyvitamin D levels with liver disease severity and calcium levels in adults with cirrhosis. This cross-sectional study included 180 adults with cirrhosis enrolled in a clinical cohort study at a single university hospital. The mean age was 58.8 (±9.2) years, and cirrhosis was attributed to alcohol use in 27.2%, hepatitis C in 35.0%, non-alcoholic steatohepatitis in 27.2%, and both alcohol and hepatitis C in 10.6%. The median model for end-stage liver disease-sodium (MELD-Na) score was 12.0 (interquartile range 9.0–16.0), and mean serum albumin levels were 3.4 (±0.7) gm/dl. Median serum 25-hydroxyvitamin D levels were 28.0 (interquartile range 20–38) ng/mL, with 16 patients (8.9%) having levels &lt;12 ng/ml and 43 (23.9%) with 25(OH)D levels &lt;20 ng/ml. No correlation was noted between levels of 25-hydroxyvitamin D and albumin-corrected calcium in the total group and in groups stratified by vitamin D supplementation. In contrast, both serum albumin (r = 0.32; P &lt; 0.001) and MELD-Na scores were significantly correlated with 25-hydroxyvitamin D levels (r = –0.29; P &lt; 0.001). Correlations between 25-hydroxyvitamin D levels and serum albumin (r = ?0.39; P &lt; 0.001) and MELD-Na scores did not change substantially after excluding 67 patients receiving vitamin D supplementation (r = ?0.33; P = 0.009). In conclusion, total 25-hydroxyvitamin D levels correlate inversely with liver disease severity in adults with cirrhosis.

Thyroid hormone status in children with protein energy malnutrition a hospital based case control study

Background: WHO estimates that about half of all deaths, occurring among children aged less than five years in the developing countries, can be attributed to malnutrition. In malnourished children various endocrinal changes are noted. There is reduced synthesis of plasma proteins that affects secretion and metabolism of thyroid hormone. The present study has been conducted to study the effect of protein energy malnutrition (PEM) on thyroid hormone and plasma protein levels; and to find correlation between thyroid hormones and plasma protein levels in PEM children.Methods: A cross sectional hospital based case-control study was carried out in tertiary care hospital of Northern India. 50 children with PEM, and equal number of age and sex matched healthy controls (1-5 years) were included in the study. Detailed clinical assessment of nutritional status followed by anthropometric measurement was recorded in a predesigned performa. The cases were categorized into moderate and severe malnutrition as per WHO classification (weight for height). Free Triiodothyronine (fT3), free Thyroxine (fT4), thyroid stimulating hormone (TSH), serum total protein and serum albumin were estimated. The parameters were compared among cases and controls using appropriate statistical tool. Results: Mean hemoglobin, serum protein, serum albumin, fT3, fT4 and TSH levels were significantly low in case group, when compared to the control group (p &lt;0.001).The levels of biochemical variables, decreases as the severity of malnutrition increases. The difference within the cases (moderate and severe malnutrition) was also found to be statistically significant (p &lt;0.001).Conclusions: PEM is associated with decrease level of thyroid hormone levels and were positively correlated with serum total protein and albumin levels. The decrease level of thyroid hormone may have a contributory role in retarded growth and development.

Aortic Arch Calcification as a Predictor of Repeated Arteriovenous Fistula Failure within 1-Year in Hemodialysis Patients.

Objectives The aim of the study was to identify the factors associated with repeated arteriovenous fistula (AVF) failure within 1-year, especially the impact of aortic arch calcification (AAC) on patency of AVF. Materials and Methods We retrospectively assessed chest radiography in hemodialysis patients who had undergone initial AVF. The extent of AAC was categorized into four grades (0–3). The association between AAC grade, other clinical variables, and repeated failure of AVF was then analyzed by binary logistic regression analysis. Results This study included 284 patients (158 males, mean age 61.7 ± 13.1 years). Patients with higher AAC grade were older, had more frequently diabetes mellitus and cardiovascular disease, had lower diastolic blood pressure, and had higher corrected calcium and lower intact parathyroid hormone levels. In multivariate analysis, the presence of higher AAC grade (odds ratio (95% confidence interval): 2.98 (1.43–6.23); p = 0.004), lower mean corrected calcium (p = 0.017), and mean serum albumin level (p = 0.008) were associated with repeated failure of AVF. Conclusions The presence of higher AAC grade, lower mean corrected calcium and mean serum albumin level were independently associated with repeated AVF failure within 1 year in hemodialysis patients.

Serum albumin levels and their correlates among individuals with motor disorders at five institutions in Japan.

BACKGROUND/OBJECTIVESThe level of serum albumin is an index of nourishment care and management. However, the distribution and correlates of serum albumin levels among individuals with motor disorders have not been reported until now. Therefore, we examined the distribution and correlates of serum albumin levels among individuals with motor disorders.SUBJECTS/METHODSA cross-sectional study on 249 individuals with motor disabilities (144 men, mean age: 51.4 years; 105 women, mean age: 51.4 years) was conducted at five institutions in Ibaraki Prefecture, Japan in 2008. The results were compared with data from the National Health and Nutrition Survey.RESULTSThe mean serum albumin levels were 4.0 ± 0.4 g/dL for men and 3.8 ± 0.5 g/dL for women. Overall, 17 (11.8%) men and 25 (23.8%) women had hypoalbuminemia (serum albumin level ≤ 3.5 g/dL); these proportions were greater than those among healthy Japanese adults (≤ 1%). Low serum albumin level was related with female sex, older age, low calf circumference, low relative daily energy intake, low hemoglobin (Hb), low blood platelet count, low high-density lipoprotein cholesterol (HDL-C), low HbA1c, and high C-reactive protein (CRP) levels. The strongest correlates, based on standardized betas, were Hb (0.321), CRP (-0.279), and HDL-C (0.279) levels.CONCLUSIONSThese results indicate that the prevalence of hypoalbuminemia is higher in individuals with motor disabilities than in healthy individuals and that inflammation is a strong negative correlate of serum albumin levels. Therefore, inflammation should be examined for the assessment of hypoalbuminemia among institutionalized individuals with motor disabilities.

Correlation between Serum Cholesterol and Serum Albumin Level in Childhood Nephrotic Syndrome

1.1.Hypercholesterolemia, a common secondary laboratory abnormality, is very prevalent in children with nephrotic syndrome. 1.2.Objective: The aim of this study was to evaluate the direct relationship between serum cholesterol and serum albumin in childhood nephrotic syndrome. 1.3.Patients and method:This cross sectional comparative study was performed on 60 children with the age of 2 years to 8 years with nephrotic syndrome in Department of Pediatric Nephrology, Comilla Medical College Hospital from January 2013 to December 2013. Serum albumin and serum cholesterol was measured by enzymatic colorimetric method. The relationship between serum cholesterol and serum albumin was measured by Pearson’s correlation. 1.4.Results: The mean cholesterol level in cases was 240(±07) mg/dl. And mean serum albumin level of cases was (1.88±.37)mg/dl. Pearson’s correlation test between serum cholesterol and serum albumin level of cases were significant (p=<0.05). 1.5.Conclusion: These results suggest that in the childhood nephrotic syndrome, there is a negative correlation between serum cholesterol level and serum albumin level.

Risk factors for cardiopulmonary dysfunction in early-onset severe pre-eclampsia

ObjectiveTo explore associations between patient characteristics and cardiopulmonary function among patients with early-onset severe pre-eclampsia being treated with expectant management. MethodThe present retrospective study included patients who received expectant management for early-onset pre-eclampsia between January 1 and December 31, 2014 at Shanghai Jiao Tong University School of Medicine, China. Patients were divided into two groups based on cardiopulmonary function, a decompensatory group and a normal group. The clinical characteristics of patients in the two groups were compared by binary logistic regression analysis and using the Student t test. ResultsData from 93 patients were included in the analysis. Serum creatinine levels (P=0.017), ascites (P=0.001), and increased proteinuria (P=0.015) were associated with decompensation of cardiopulmonary function during early-onset severe pre-eclampsia. Hypoproteinemia was associated with significantly increased odds of ascites occurring (odds ratio 3.16; 95% confidence interval 1.34–7.44) and the mean serum albumin level was higher in patients without ascites (P<0.001). ConclusionsRenal insufficiency and ascites were associated with cardiopulmonary dysfunction. Ascites should receive greater medical attention during the expectant management of early-onset severe pre-eclampsia.

Diabetes Mellitus Increases the Severity of First Episode of Overt Hepatic Encephalopathy in Decompensated Cirrhosis

Background and Aim: Diabetes mellitus is associated with a state of increased inflammation as a result of increased bacterial translocation due to reduced intestinal transit time and SIBO. Diabetes mellitus may alter the course of hepatic encephalopathy (HE) in decompensated cirrhosis. With the increase in cases of NASH related cirrhosis it has become important to study the relation of diabetes with respect to HE as it is one of the main complication in decompensated cirrhosis which affects quality of life. The aim of the study was to identify the role of diabetes mellitus in the development of first episode of overt HE in patients with decompensated cirrhosis. Methods: We conducted a retrospective case control study in the study period January 2015 to December 2015. We enrolled consecutive patients with decompensated cirrhosis of any etiology with overt HE (grade 2–4) and divided them into two groups, those with diabetes (Group I) and those without diabetes (Group II). Severe HE was defined as grade 3 HE and above. Results: A total of 96 patients with overt HE were enrolled of which 58 (60.41%) patients were diabetic (Group I). Severe HE was seen in total of 34 (35.4%) patients of which diabetics were 29 (P < 0.001). The mean serum albumin level in Group I was 2.78 ± 0.32 g/dl and in Group II was 2.54 ± 0.40 g/dl (P = 0.002). The mean INR in Group I vs Group II was 1.76 ± 0.44 vs 2.02 ± 0.57 (P = 0.011). Ammonia levels were higher in Group I which was 87.33 ± 21.72 as against 78.87 ± 22.31 in Group II (P = 0.068). On multivariate analysis infections, severity of HE, serum albumin and age were significant. Conclusion: Diabetic patients had more severe grades of HE and it occurred at lesser biochemical decompensation. The authors have none to declare.

Serum Albumin Levels In Edematous Severe Acute Malnutrition Children Aged 6 Months to 5 Years.

Objective: To Study the serum albumin levels in edematous severe acute malnutrition children aged 6months to 5 years.Methods: An observational hospital based prospective study was conducted at Malnutrition Treatment Center (MTC), Bal Chikitsalya, RNT Medical College, Udaipur (Raj.) India from July 2015 to Dec 2015. We enrolled total 50 children aged 6 Months to 5 Years having nutritional edema with medical complications. Acute complications were treated and nutritional rehabilitation was done by WHO protocols.Results: A total of 50 children were studied. Mean age of children was 16.5411.05 months, 52.0% were males and 48.0% were females. Majority of children had moderate edema(52.0%) followed by 34.0%of severe edema whereas only 14.0% of SAM children had mild edema. Mean serum albumin levels were 2.7 50.74 gm/dl. Serum albumin levels were, In mild grade edema(1+), 3.270.60 gm/dl, in moderate grade edema(+2) 2.85 0.74gm/dl and in severe grade edema(3+) 2.38 0.63 gm/dl.. Serum albumin levels were statistically significantly associated with grade of edema (p value=0.01).Conclusion: This study concluded that edematous severe acute malnutrition children had hypoalbuminemia and this hypoalbuminemia statistically significant with grade of edema.

Interphase Fluorescence in Situ Hybridization Analysis of Cytogenetic Abnormalities in Egyptian Patients with Plasma Cell Myeloma

Background: Cytogenetic abnormalities are ubiquitous in plasma cell myeloma representing the hallmark of the disease. These abnormalities have been used as the foundation to establish prognostic factors for accurate risk stratification in plasma cell myeloma. The present study aimed to detect the incidence 14q32 IgH rearrangements, t(11;14), t(4;14), 13q del and 17p del by Interphase Fluorescence in Situ Hybridization (iFISH) and their relation to the standard prognostic factors and patients’ outcome . Method: Thirty one newly diagnosed Egyptian myeloma patients were tested for the expression of 14q32 IgH rearrangements by using the locus specific identifier (LSI) IGH Dual Color FISH break apart rearrangement probe, we also used the LSI IGH/CCND1 Dual Color Dual Fusion Probe for detection of t(11;14)(q13;q32), LSI IGH/FGFR3 Dual Fusion Probe for detection of t(4;14)(p16;q32), LSI D13S319 (13q14.3) probe for detection of 13q del and LSI TP53 Probe for detection of 17p del on bone marrow samples collected from the patients at diagnosis. Results: Abnormal iFISH results were found in 21 patients (67.7%) of the 31 examined patients. Ten patients (32.3%) exhibited 14q IgH rearrangement. Both t(11;14) and t(4;14) were found in 4 patients (12.9%). 17p13 del was detected in 3 patients (9.7%) while 8 patients (25.8%) showed positive results for 13q del. There were statistical significant decrease in mean total leucocytic count (P= 0.030) and mean serum albumin level (P= 0.008) in patients showing positive genetic abnormalities detected by iFISH whereas a significant increase in β2-microglobulin level (>5.5mg/dL) (P= 0.052) and kappa light chain (P= 0.015) were found in those patients. A statistically significant lower serum calcium ( 300 IU/L) (P= 0.003). Patients with positive t(4;14) had significantly older age (over 60 years) (P= 0.018) and lower platelet counts ( 4x10 9 /L) (P= 0.002). Patients with positive 13q del had significantly lower mean

Association of Serum Albumin Level and Mortality in Premature Infants.

Hypoalbuminemia has been proven to be a powerful predictor of mortality in adult patients. However, prognostic value of serum albumin in neonates is not clear. To assess the relationship between serum albumin level within the first day of life and outcome in preterm infants born before 32 weeks of gestation. The study was conducted prospectively in Baskent University Hospital between October 2008 and November 2009. Patients were divided by gestational age into two groups as below or of 28 weeks and above 28 weeks. Then serum albumin percentile groups were established within each gestational age group and were defined as <25, 25-75, and >75 percentile groups by combining percentile groups between the two gestational age groups. Three serum albumin percentile groups were compared regarding neonatal outcomes. A total of 199 infants with mean birth weight of 1,272 ± 390 g and mean gestational age of 29.2 ± 2.2 weeks were admitted to the study. The mean serum albumin level was 30.6 ± 4.7 g/l for all patients. The mean serum albumin levels were 25.5 ± 3.8, 30.1 ± 2.7, and 35.3 ± 3.7 g/l for <25, 25-75, and >75 percentile groups, respectively. Prevalence of infants with respiratory distress syndrome and prevalence of infants with sepsis and mortality were significantly higher in <25 percentile group. Logistic regression analysis showed that serum albumin <25 percentile and birth weight were independent predictive variables of mortality. Albumin concentrations lower than 27.2 g/l was associated with mortality, with a sensitivity of 71% and a specificity of 86%. Low serum albumin level within the first day of life is an independent predictor of mortality in preterm infants.

Prognostic Value of Rising Serum Albumin During Hospitalization in Patients With Acute Heart Failure

Hypoalbuminemia is an important predictor of a poor long-term prognosis in acute heart failure (AHF). However, changes in serum albumin levels in AHF have not been described to date. Therefore, we investigated the changes in serum albumin levels in patients hospitalized for AHF. This observational study included 115 consecutive patients admitted with AHF. Serum albumin was measured on days 1, 2, 4, and 7 of their hospitalization, and the changes in its levels were assessed. Cox multivariate analysis was used to compare the long-term mortality and readmission rate between 2 groups defined according to whether their serum albumin changes showed a rising pattern (serum albumin level increased from day 2 to day 7) or not. The mean serum albumin levels were 3.51mg/dl on day 1, 3.21mg/dl on day 2, 3.23mg/dl on day 4, and 3.35mg/dl on day 7 (p <0.001 by multivariate analysis of variance). The rising pattern group including 66 patients (60.6%) was independently associated with a lower mortality and readmission rate (hazard ratios 0.450 and 0.522; p=0.01 and 0.02, respectively). Furthermore, based on multiple linear regression analysis, the changes in hemoglobin and C-reactive protein levels during days 1 to 7 were independently correlated with the changes in serum albumin levels over the same period. In conclusion, a rising pattern of serum albumin change in a patient with AHF was correlated with a good long-term prognosis. Furthermore, the change in serum albumin levels was also associated with changes in cachectic factors.