Normal Albumin Levels Research Articles

Association between immediate postoperative hypoalbuminemia and surgical site infection after posterior lumbar fusion surgery.

In this study, we intended to investigate the association between immediate postoperative hypoalbuminemia and surgical site infection (SSI), and determine a threshold value for postoperative hypoalbuminemia that can assist in risk stratification in patients after posterior lumbar fusion surgery. From January 2017 to December 2021, 466 consecutive patients who underwent posterior lumbar fusion surgery were selected to analyze the relationship between immediate postoperative hypoalbuminemia and SSI. Multivariate logistic regression analysis was performed to identify the independent risk factors of SSI and postoperative hypoalbuminemia. Receiver Operating Characteristic (ROC) analysis was used to determine the optimal value for postoperative hypoalbuminemia, and subsequent grouping was based on the identified threshold. Of the total 466 patients, 25 patients (5.4%) developed SSI after surgery, and lower postoperative albumin (OR: 0.716, 95% CI: 0.611-0.840, p < 0.001) was independently associated with SSI. ROC analysis showed that the cutoff value of postoperative hypoalbuminemia was 32g/L with a sensitivity of 0.760, specificity of 0.844, and a Youden index of 0.604. Postoperative SSI was more common in patients with postoperative hypoalbuminemia than in those without (21.6% vs. 1.6%, p < 0.001). Age, gender and operative duration were found to be independent predictors of postoperative hypoalbuminemia. This study showed that immediate postoperative hypoalbuminemia was an independent risk factor for the development of SSI in patients who underwent posterior lumbar fusion. Even in patients with a normal preoperative serum albumin level, there was an increased risk of SSI when the postoperative albumin within 24h was < 32g/L.

The Association of Pre-operative Serum Albumin Levels and Post-operative In-Hospital Death in Patients Undergoing Gastrointestinal Surgeries in Thailand: A Retrospective Cohort Study.

Pre-operative hypoalbuminemia is known to predict negative outcomes for patients undergoing major surgeries. However, various cut-off points for starting exogenous albumin have been recommended. This study investigated the association between pre-operative severe hypoalbuminemia, in-hospital death, and length of hospital stay in patients undergoing gastrointestinal surgery. A retrospective cohort study using a database analysis was undertaken on hospitalized patients who underwent major gastrointestinal surgery. The pre-operative serum albumin level was classified into three groups: severe hypoalbuminemia (<2.0 mg/dL) and non-severe hypoalbuminemia (≥2.0-3.4 g/dL) and normal level (3.5-5.5 g/dL). To compare between different cut-offs, a sensitivity analysis using another albumin level classification as severe hypoalbuminemia (<2.5 mg/dL) and non-severe hypoalbuminemia (≥2.5-3.4 g/dL) and normal level (3.5-5.5 g/dL) was applied. The primary outcome was post-operative in-hospital death. Propensity-score adjusted regression analyses were applied. A total of 670 patients were included. Their average age was 57.4 ± 16.3 years, and 56.1% were men. Only 59 patients (8.8%) had severe hypoalbuminemia. Overall, a total of 93 in-hospital deaths (13.9%) occurred among all included patients, but there were 24/59 (40.7%) deaths among patients with severe hypoalbuminemia, 59/302 (19.5%) deaths among patients with non-severe hypoalbuminemia, and 10/309 (3.2%) deaths among patients with normal albumin level. The adjusted odds ratio for post-operative in-hospital death comparing patients with severe hypoalbuminemia and patients with normal albumin level was 8.11 (3.31-19.87; p < 0.001), while the odds ratio for in-hospital death comparing patients with non-severe and patients with normal albumin level was 3.89 (1.87-8.10; p < 0.001). A sensitivity analysis showed similar findings, the odds ratio for in-hospital death for severe hypoalbuminemia (cut-off as <2.5 g/dL) was 7.44 (3.38-16.36; p < 0.001), while the odds ratio for in-hospital death for severe hypoalbuminemia (cut-off as 2.5-3.4 g/dL) was 3.02 (1.40-6.52; p = 0.005). Severe pre-operative hypoalbuminemia in patients undergoing gastrointestinal surgery was associated with an increased risk of in-hospital mortality. The risk of death for patients with severe hypoalbuminemia was relatively similar when using different cut-offs such as <2.0 and <2.5 g/dL.

Comparing the effect of Hypoalbuminemia on Sodium measured by Indirect versus Direct Ion Selective Electrode Method

Objective: To evaluate the effect of low serum Albumin levels on serum sodium measurement when analyzed by the indirect Ion Selective Electrode (ISE) method and to compare the results with the direct Ion selective electrode (ISE) method.&#x0D; Study Design: Cross-sectional study&#x0D; Place and Duration of Study: Department of Chemical Pathology, Armed Forces Institute of Pathology, Rawalpindi Pakistan, from Jan to Mar 2021.&#x0D; Methodology: Patients of either gender, aged 18 to 70 years, who were admitted to the Intensive Care Unit of Combined Military Hospital, Rawalpindi, were selected. A total of 200 blood samples were collected in a gel tube. Serum samples were analyzed for albumin and sodium within two hours of sample collection. Sodium levels were measured concurrently by both direct and indirect ISE methods. The difference in results between these two techniques was studied.&#x0D; Results: Hypoalbuminemia was detected in 176(88%) patients, while 24(12%) had normal albumin levels. In Hypoalbuminemic patients, serum sodium measurements were higher using the indirect ISE method(134.07±5.55) compared to the direct ISE method (130.95±6.04); the difference between the two techniques was statistically significant (p-value &lt;0.001).Pearson correlation coefficient (r-value = -0.86, p-value &lt;0.001) revealed a symmetrical increase in differences between the two methods as the albumin level decreased.&#x0D; Conclusion: In Hypoalbuminemic patients, the indirect ISE method gave falsely raised results of serum sodium. In such patients, serum sodium measurement by the Direct ISE method offers more accurate and consistent electrolyte results.

Relationship between Albumin Levels and the Incidence of Ascites in Patients with Liver Cirrhosis

Background: Patients with cirrhosis often develop hypoalbuminemia. In conditions of hepatic dysfunction, albumin synthesis is decreased due to hepatic dysfunction and abnormal distribution of portal blood flow. Ascites is a major complication and an important sign in the course of cirrhosis and is associated with 50% mortality after two years. 75% of patients' ascites etiology is liver cirrhosis, 10% malignancy, 3% heart failure, 2% tuberculosis, 1% pancreatitis, and others.&#x0D; Methods: This cross-sectional study was conducted from the medical records of patients with liver cirrhosis who were treated at the internal medicine section of Dr. M Djamil General Hospital, Padang, in 2015-2020. Patients with heart defects, malignancy, tuberculosis, pancreatitis, kidney failure, and incomplete medical record data were excluded from the study. Patients were grouped according to the presence or absence of ascites and albumin levels. Analysis using the chi-square test in 2020.&#x0D; Results: From 225 cases, 103 cases were analyzed. 77 were men (74.8%), and 26 were women (25.2%). The age of the patient was in the range of 40-60 years. No ascites were found in 30 people (29.1%), and 73 people (70.9%) had ascites. From normal albumin levels, five were without ascites, and four were with ascites. On mild hypoalbumin, 13 had no ascites, and 38 people had ascites. On severe hypoalbumin, 12 people were without ascites and 31 with ascites. A chi-square test was analyzed, and it was found that there was no relationship between the incidence of ascites and albumin levels (p 0.182).&#x0D; Conclusion: The incidence of ascites is not related to blood albumin levels.

Preoperative frailty to predict short-term outcomes in patients with cancer.

810 Background: Frailty is associated with increased postoperative complications. Despite multiple evidence-based modalities to assess frailty, surgeons often make subjective assessments of patients’ ability to tolerate surgery. Identification of those at risk of poor outcomes is particularly important in Surgical Oncology, as major resections may worsen debility and functional status, limiting the patients' ability to receive further therapy. The Risk Analysis Index (RAI-C) is a validated tool to assess frailty in surgical patients. It assigns points for any cancer diagnosis, potentially overestimating frailty in Surgical Oncology patients, and has not been validated in this subgroup. Methods: We performed a prospective, surgeon-blinded study to correlate results of a preoperatively administered frailty survey to predict short- and long-term outcomes in patients with histologically proven malignancy who underwent surgery. The RAI-C, Patient Health Questionnaire (PHQ9), and General Anxiety Disorder (GAD) surveys were administered to assess for frailty, depression, and anxiety, respectively; C-reactive protein (CRP), pre-albumin, albumin, and hematocrit were obtained. Outcomes, including readmission, major complications, ICU admission, disposition (home vs rehabilitation/nursing facility), and 1-year survival were compared between the different groups as defined by survey and lab results. Results: One hundred ninety-one patients were included, of which 135 patients were considered frail based on the predefined value (RAI-C ≥21). Frail patients were more likely to be readmitted within 30 days (14% vs 2%, P=0.01). No difference was found in length of stay, 90-day readmission, ICU admission, major complications, or disposition. Only 15.8% of patients met criteria for anxiety and 11% met criteria for depression. Measured outcomes were similar in patients defined as anxious or depressed. Patients with abnormal pre-albumin levels were more likely to require ICU admissions (31% vs 8%, P &lt;0.005), postoperative intubation (12% vs 0.02%, P=0.02), and to be discharged to a facility other than home (19% vs 10%, P=0.01). Similar trends were noted for patients with abnormal albumin levels who also had longer lengths of stay (mean 9.32 vs 7.88 days, P=0.007). There was an association of improved 1-year survival in patients with normal CRP, pre-albumin, albumin, and hematocrit levels. Frailty as determined by RAI-C survey was not associated with decreased 1-year survival. Conclusions: The RAI-C is a validated tool that can be used for prescreening of Surgical Oncology patients at risk of postoperative readmission, however the score did not correlate with other important outcomes including major morbidity, discharge disposition, and 1-year survival. Results from the survey, as well as preoperative laboratory results can be used in screening patients who may benefit from preoperative optimization and increased follow-up.

P150 Identification of features associated with poor outcomes in pediatric patients with ulcerative proctitis: A Multicentre Study From the Paediatric IBD Porto Group of ESPGHAN

Abstract Background Ulcerative proctitis (UP) is an uncommon presentation in paediatric patients with ulcerative colitis, accounting for &amp;lt;10% of cases. Here we aimed to characterize the clinical features and natural history of paediatric patients with UP, and to identify predictors of poor outcomes. Methods A retrospective cohort study involving 37 sites affiliated with the IBD Interest group of ESPGHAN. Data were collected at different timepoints from patients diagnosed with UP aged &amp;lt;18 years between 01/01/2016-31/12/2020. Outcomes included time to initiation of systemic steroids, thiopurines or biologics, time to acute severe colitis (ASC), IBD-related admission and colectomy. Univariate cox regression was used to study the association between potential predictors and study outcomes. Results Two hundred and fifty patients with UP were included, with a median age at diagnosis of 14.5 (IQR 12.3-15.9) years, and a median follow-up of 2.7 (IQR 1.7-3.9) years. The most common presenting symptoms were bloody stools (94%), abdominal pain (59%) and diarrhea (53%). At diagnosis, the median pediatric ulcerative colitis activity index (PUCAI) score was 25 (IQR 20-35), and only 3 patients (1.3%) presented with ASC. Most children had normal inflammatory markers and albumin levels. the median fecal calprotectin level was 720 mcg/g (IQR 310-1800), while 16 patients (9.9%) had a calprotectin level &amp;lt;100mcg/g at diagnosis. Administration of oral or topical 5-ASA resulted in clinical remission rates of 52% and 48%, respectively, by the end of induction, while the combination of both led to remission in 73% of patients. The rates of treatment escalation to thiopurines and biologics at 1, 3 and 5 years were 11%, 27% and 45%, and 11%, 23% and 45%, respectively (Figure 1). Within 5 years from diagnosis, 20% of patients had presented with ASC. The PUCAI score at diagnosis of UP was highly associated with initiation of systemic steroids, thiopurines or biologics, as well as later ASC event and IBD admission, while a Mayo endoscopic score of 3 was associated with the initiation of biologics and subsequent ASC event and IBD admission (Table 1). Seven patients (4%) underwent colectomy by the end of follow-up. Among the 151/250 patients who had a repeat endoscopy, only 16% achieved mucosal healing and in 48% inflammation extended proximally. Cecal patch (P=0.009) and higher PUCAI score (P=0.009) at diagnosis, as well as higher PUCAI score (P=0.009) and lack of steroid-free clinical remission (P=0.005) by the end of induction were associated with proximal disease extension. Conclusion Disease burden is significant in paediatric patients that present with UP, with high rates of proximal disease extension and requirement for treatment escalation.

Correlation Between Preoperative Serum Albumin Levels And Post-Operating Seroma Incidence Of Modified Radical Mastectomy In Breast Cancer Patients

Background: Surgical therapy is still the mainstay of therapy for breast cancer, and modified radical mastectomy (MRM) is the most frequently performed procedure. Seroma formation after breast surgery is a complication that is often found due to the formation of dead space anatomically. A low albumin level indicates an ongoing systemic response and is a one of marker for a seroma. Aim To determine the postoperative complications of modified radical mastectomy in breast cancer patients, namely the incidence of postoperative seroma with preoperative serum albumin levels. Methods: An analytic observational study using a cross sectional study design conducted at the medical record of Prof. Dr. IGNG Ngoerah Denpasar Hospital in January 2019-December 2021. The research subjects were all patients with breast cancer underwent MRM. This study’s data analysis consisted of univariate and bivariate analysis using IBM SPSS version 23. Results: 128 subjects divided into two groups, 30 subjects with seroma and 98 subjects without seroma. Low albumin levels &lt;3.5 gr/dl in the seroma group were found in 18% case and in the group without seromas 39.1%, normal albumin levels &gt; 3.5 gr/dl with seromas occurring in 5.5% respondents and normal albumin levels without seroma found 37.5% respondents. The RR value was 2.4 (CI 95% 1.14-5.34) with a p-value of 0.013. Conclusion: Pre-operative low albumin level &lt; 3.5 gr/dl correlated to high seroma formation after modified radical mastectomy.

Examining Albumin as a Bioindicator of Healing Capability in Patients With Diabetic Foot Ulcers: A Retrospective Review

Introduction. Identifying a bioindicator of healing capacity would be beneficial in guiding treatment of and reducing morbidity in patients with DFU. Hypoalbuminemia is a well-established risk factor for amputation and, thus, a promising candidate. Objective. This study was conducted to examine whether albumin values over a 12-week treatment course for DFU correlated with ulcer size and outcomes. Materials and Methods. A retrospective review was conducted of 793 patients who presented to the Atrium Health Wake Forest Baptist Wound Care and Hyperbaric Center between 2010 and 2022. Sixty-two patients met the inclusion criteria. Albumin values and wound size data were collected monthly over a 12-week treatment course. Results. Initial albumin values were not significantly different between patients healed by 12 weeks compared with nonhealed patients. Healed proportion and average initial ulcer size in patients with at least 1 hypoalbuminemia value (&lt;3.0 g/dL) were not significantly different from those in patients with normal albumin levels. Patients who trended from normoalbuminemia to hypoalbuminemia displayed significantly increased wound sizes compared to patients with albumin changes within the normal range (0.04 cm² and −1.17 cm², respectively; P &lt; .05). Monthly changes in albumin correlated poorly with wound healing (r = 0.144, P = .240), and large negative albumin trends (&gt;0.5 g/dL per month) did not correlate with increased wound sizes compared with stable or positive trends. Conclusion. Albumin’s utility as a bioindicator of short-term healing capability is limited to below-normal values.

The role of the nutritional status of geriatric patients with gastrointestinal cancer in developing postoperative complications

Background: Many studies have shown that geriatric patients with altered nutritional status are at higher risk of developing complications during medical treatment. Our study aimed to examine the role of preoperative nutritional status in developing postoperative complications and the length of hospital stay in geriatric patients who suffer from cancer and undergo major abdominal surgery. Methods: Prospective research was conducted at the Oncology Institute of Vojvodina from January 2020 until April 2021. This study included 82 patients over 65 years old, who were admitted to have radical surgery for gastrointestinal cancer performed. There were 6 patients excluded from the study. Nutritional status analysis was performed using BMI (Body mass index), preoperative serum albumin level, MNA-SF (Mini nutritional assessment- short form), and GNRI (Geriatric nutritional risk index). The classification of surgical complications was done using the Clavien-Dindo classification scale. Results: Of the total number of patients, 57 of them (75%) developed at least one surgical complication. Nonsurgical complications have been recognized in 28 patients (36.84%). Overweight patients, according to BMI, had a greater chance of developing grade I (p &lt; 0.01) and grade II (p &lt; 0.05) surgical complications of the Clavien-Dindo classification. Patients with normal serum albumin levels had a significantly lower chance of developing surgical complications of any grade (p = 0.00). BMI and MNA- SF were the most important predictors of delirium. Patients without GNRI risk (GNRI: &gt;98) had a significantly lower chance of developing nonsurgical complications regarding comorbidity exacerbation (p = 0.03), and delirium (p = 0.00). Conclusion: None of the nutritional assessment tools used in our study were better or more efficient than the others in our sample of patients. Precise nutritional status assessment is complex and we cannot use only one scoring system or scale to get accurate results.

Association of Low Serum Albumin Levels and its In-hospital Adverse Outcomes among Patients Presenting with Acute Coronary Syndrome in a Tertiary Care Hospital of West Bengal, India

Introduction: Acute Coronary Syndrome (ACS) is characterised by hypercoagulability and inflammation. In acute presentation of Ischaemic Heart Disease (IHD), like ACS, serum albumin may also play an important role. Many patients with ischaemic cerebrovascular accident, a condition similar to ACS, had low serum albumin. Aim: To estimate serum albumin levels in patient with ACS and its relation to hospital adverse outcome. Materials and Methods: The present prospective observational study was conducted in the Department of General Medicine at R.G. Kar Medical College and Hospital, West Bengal, India. The duration of the study was 18 months, from July 2019 to October 2020. Patients with ACS were included irrespective of age, sex, race and predisposing factors such as Hypertension (HTN), Diabetes Mellitus (DM), hyperthyroidism and dyslipidaemia. A total of 125 patients included and details such as relevant history, examination findings, laboratory investigation, Electrocardiography (ECG), Echocardiography (ECHO), chest X-ray Posteroanterior (PA) view were included. Chi-square test and logistic regression were applied. Results: A total of 94 (75.2%) patients were males. 49 (39.2%) study patients had DM. Total 10 (8%) patients presented with cardiac arrest at admission. In-hospital death was happened in 9 (7.2%) cases. 59 (47.2%) patients had normal serum albumin level (3.5-4.5). 61 (48.8%) had mild to moderate hypoalbuminaemia (2.5-3.5) and only 5 (4%) had severe hypoalbuminaemia (&lt;2.5). Association of inhospital complication vs serum albumin level was statistically significant (p&lt;0.0001). A multivariate logistic regression analysis showed that male gender (p-value=0.026), smoking (p-value=0.008), arrhythmia (p-value=0.002), increased creatinine (p-value=0.032) and hypoalbuminaemia (p&lt;0.001) were statistically significant independent predictors of inhospital adverse outcomes. Conclusion: The low serum albumin level, measured immediately on hospital admission in ACS patients was associated with in-hospital complications, and when adjusted for other covariates, hypoalbuminaemia predicts in-hospital adverse outcome independently.

Molecular Pathways of Diabetic Kidney Disease Inferred from Proteomics

Diabetic kidney disease (DKD) affects an estimated 20-40% of type 2 diabetes patients and is among the most prevalent microvascular complications in this patient population, contributing to high morbidity and mortality rates. Currently, changes in albuminuria status are thought to be a primary indicator of the onset or progression of DKD, yet progressive nephropathy and renal impairment can occur in certain diabetic individuals who exhibit normal urinary albumin levels, emphasizing the lack of sensitivity and specificity associated with the use of albuminuria as a biomarker for detecting diabetic kidney disease and predicting DKD risk. According to the study, a non-invasive method for early detection or prediction of DKD may involve combining proteomic analytical techniques such second generation sequencing, mass spectrometry, two-dimensional gel electrophoresis, and other advanced system biology algorithms. Another category of proteins of relevance may now be provided by renal tissue biomarkers. The establishment of reliable proteomic biomarkers of DKD represents a novel approach to improving the diagnosis, prognostic evaluation, and treatment of affected patients. In the present review, a series of protein biomarkers that have been characterized to date are discussed, offering a theoretical foundation for future efforts to aid patients suffering from this debilitating microvascular complication.

602. Clinical Outcomes of Ertapenem in Patients with Hypoalbuminemia

Abstract Background Infections caused by extended-spectrum ß-lactamase (ESBL) producing organisms pose a unique challenge for infection control. The preferred agents for treatment of infections due to ESBL-producing bacteria are carbapenems. Data from prior studies suggest that hypoalbuminemia may have a profound effect on the pharmacodynamic properties of ertapenem. Our hypothesis is that ertapenem usage in patients with hypoalbuminemia will lead to negative clinical outcomes such as infection recurrence, hospital readmission, and mortality when compared to subjects with higher albumin levels. Methods This was a retrospective, observational, single-centered, cohort study of hospitalized patients at Loyola University Medical Center between January 2010 and August 2020. Patients were divided into 2 groups to include those who received ertapenem with serum albumin &amp;gt;2.5 g/dL and those who received ertapenem with serum albumin &amp;lt; 2.5 g/dL. The primary outcome of interest was 30-day all-cause mortality. Baseline characteristics that were collected included age, sex, nutrition status, patient comorbidities. Data regarding predictors of mortality within 24 hours of initiation of ertapenem including the Acute Physiology and Chronic Health Evaluation (APACHE) II score and the Charlson Comorbidity Index (CCI) was also collected. Study Criteria Results Of the 146 subjects that were included, 73 patients had serum albumin levels of &amp;lt; 2.5 g/dL during treatment with ertapenem. 30 day all-cause mortality was 19.7% for subjects with low albumin and 9.6% for subjects with normal albumin levels (p=0.09). Our study found that although not statistically significant, there is potentially a clinical significance between hypoalbuminemia and our primary endpoint, 30-day all-cause mortality, with higher rates of mortality in the low albumin group and a 9.6% between group difference. This data suggests that in subjects with hypoalbuminemia, treatment with once-daily ertapenem may lead to suboptimal outcomes regarding patient mortality. Outcome Data Conclusion The present study data suggests that in subjects with hypoalbuminemia, treatment with ertapenem dosed as a once-daily intravenous infusion may be associated with suboptimal clinical outcomes that may include an increased mortality, hospital readmission, and length of stay. Disclosures All Authors: No reported disclosures.

Relationship Between Nutritional Parameters and Quality of Life in Patients With End-Stage Kidney Disease on In-Centre Haemodialysis in Al-Ahsa, Saudi Arabia.

Nutrition threatens the quality of life (QOL) in end-stage kidney disease (ESKD) patients on haemodialysis (HD). The aim of the study is to assess which nutritional parameters associate with the health-related QOL category score usingArabic translated, adapted, and validated version of the Kidney Disease Quality of Life Short-Form 36 (KDQOL-36). We carriedout a cross-sectional study with a total of 60 ESKD patients in one haemodialysis centre in Al-Ahsa, Saudi Arabia. The health-related QOL of the five components of the KDQOL-36 are as follows: physical component score (PCS), mental component score (MCS), the burden of kidney disease (BKD), symptoms and problems of kidney disease (SPKD), and effects kidney disease (EKD) which were grouped into three categories (good, average and poor) based on the score. Of the 60 HD patients, 43 (71.7%) were between 19 and 59 years old and 41 patients (68.3%) were males. This study revealed that high haemoglobin impact PCS, MCS, SPKD, and EKD in favour of poor health-related QOL, but normal haemoglobin impacts BKD in favour of good QOL. In addition, patients who had a normal serum albumin level had good scores for MCS, BKD, SPKD, and EKD. Also, there was a significant association between Kt/V value with EKD (p=0.001). According to the findings of this study, patients with HD have poor health-related QOL outcomes than those with good nutritional status. This finding demonstrates the critical need for further articles to study this particular group of population.

High serum β2-microglobulin is a significant predictor of mortality in maintenance hemodialysis patients.

Beta2-microglobulin, a novel marker of kidney function, predicts kidney failure and mortality in the general population. However, few studies have evaluated the association of serum β2-MG level with clinical outcome in maintenance hemodialysis (MHD) patients. This prospective cohort study enrolled 303 MHD patients to investigate the factors related to β2-MG and its relationship to mortality in MHD patients. Multivariate linear regression analysis was used to examine the factors related to β2-MG level. Multivariable Cox regression was used to calculate the hazard ratios for β2-MG on all-cause and cardiovascular mortality. The median value of serum β2-MG was 44.6mg/L (interquartile range 37.60-50.40 mg/L). During the follow-up period of 24 months, there were 48 all-cause deaths (23.0%), including 36 cardiovascular causes (75.0% of all deaths). Multiple linear regression showed that dialysis duration, serum creatinine, and alkaline phosphatase were independent predictors of serum β2-MG level. Kaplan-Meier analysis revealed that mortality in MHD patients was significantly higher in low albumin patients with β2-MG > 44.6 mg/L. Cox regression analysis showed that β2-MG was a significant predictor of all-cause mortality (HR =1.122, 95% CI: 1.058-1.190, 𝑃 < 0.001) and cardiovascular mortality (HR =1.145, 95%CI: 1.065-1.123, P< 0.001) in MHD patients with low albumin level after adjusting for confounding factors. However, our results showed that serum β2-MG was not associated with mortality in MHD patients with normal albumin level. These results are supportive of the potential role of the serum β2-MG level as a predictor of mortality in MHD patients with low albumin.

The correlation between paclitaxel chemotoxicity and the plasma albumin level in cancer patients.

The aim of this study was to evaluate the pharmacokinetics of paclitaxel in cancer patients with hypoalbuminemia following paclitaxel-containing chemotherapy and to provide a reference for the prevention of adverse events (AEs) after paclitaxel administration. Peripheral blood was collected from cancer patients treated with paclitaxel. The plasma concentration of paclitaxel was determined by ultra-high performance liquid chromatography after 24 ± 8h of chemotherapy, and individual paclitaxel time above a threshold concentration of 0.05 μmol/L (Tc>0.05 ) was calculated using the population pharmacokinetic model. Haematological and non-haematological toxicities were monitored after chemotherapy, and the correlation between different chemotherapy toxicities and Tc>0.05 was evaluated using the Prism software. The enrolled patients were divided into the hypoalbuminemia group and normal albumin level group. The mean Tc>0.05 values in the normal albumin level and hypoalbuminemia groups were 36.89 and 24.93 h, respectively (P < 0.001). The risk of myelosuppression was positively correlated with Tc>0.05 . Due to the lower Tc>0.05 , the incidences of immediate AEs such as gastrointestinal reactions and rashes were higher in the hypoalbuminemia group than in the normal albumin level group, and the incidences of delayed AEs such as myelosuppression and neurotoxicity were lower in the hypoalbuminemia group. Plasma albumin level has a conclusive effect on Tc>0.05 , which can predict the potential clinical toxicity of paclitaxel. The study provides a theoretical basis for administration of paclitaxel.

Serum albumin level as a marker to predict morbidity in post COVID-19 patients admitted in a rural critical care unit

Covid-19 raged for more than two years in almost all parts of the world including India and the long term effects are yet to be studied. Presently with the availability of vaccine has reduced the suffering even after covid-19 infection. This study is aimed to understand the patient with past history of covid-19 infection and serum albumin levels and the outcome. A total of 52 patients admitted to intensive care unit with past history of COVID-19 infection, between 01.11.2021 and 31.01.2022, were enrolled in this study. The required data were collected from the records. Of the total 52 patients included in the study, 41 (78.85%) were males and 11 (21.15%) were females. Amongst these 52 patients, 18 (34.6%) were detected with hypoalbuminemia. Higher association of co-morbidities (22.22% patients) was seen in patients with hypoalbuminemia. Death rate in hypoalbuminemia group was 11.11% while that in those with normal albumin levels was only 2.94%.Patients with hypoalbuminemia and previous covid 19 infection were having higher mortality rate as compared to normoalbuminemia.

Development and Validation of a Novel Nomogram to Predict Hypoalbuminemia among Patients with Stroke in the Neurocritical Care Unit.

This study aimed to investigate hypoalbuminemia-related factors in patients with stroke in the neurocritical care unit (NCU) and to establish a nomogram model for hypoalbuminemia prediction. Data from 902 patients hospitalized for stroke in the NCU who had normal albumin levels on admission from March 2018 to December 2020 were analyzed. Logistic regression was used to identify the risk factors associated with hypoalbuminemia. A novel nomogram prediction model for hypoalbuminemia was constructed, and it was validated in an independent set (n = 233). The nomogram incorporated seven risk factors, including age, high comorbidity, mechanical ventilation, feeding routes, total protein, high-sensitivity C-reactive protein, and fibrinogen levels, and its area under the curve for predicting hypoalbuminemia in the developmental set and validation set were 0.856 and 0.870, respectively. The novel nomogram facilitates risk prediction of hypoalbuminemia among patients with stroke in the NCU, which might be useful for selecting treatment strategies and management.

Hypoalbuminemia and the Higher Risk of Perioperative Sentinel Adverse Events in Patients Undergoing Total Shoulder Arthroplasty: A Propensity Score Matched Analysis.

The purpose of this study is to examine the effect of hypoalbuminemia (HA) on sentinel adverse events after total shoulder arthroplasty (TSA). Patients who underwent primary TSA from 2015-2018 were collected from the National Surgical Quality Improvement Program (NSQIP) database. Patients with HA (serum albumin < 3.5 g/dL) were compared to patients with normal serum albumin. A probit regression model was used to estimate a propensity score. Logistic regression was performed to evaluate the effect of HA on sentinel adverse events after surgery. A total of 4,337 patients were included, 8.2% of patients had HA. Patients with HA had higher rates of sentinel adverse events (14.0% vs 5.5%, P<0.01) compared with patients who had normal serum albumin. Reoperation (4.5% vs 1.5%, P<0.01), readmission (11.2% vs 3.9%, P<0.01), urinary tract infection (0.8% vs 0.03%, p <0.01) and pulmonary embolism (1.1% vs 0.2%, P=0.01) were higher in patients with HA. The odds ratio for a sentinel event for patients with HA was 2.6 (95% CI: 1.54, 4.44, P<0.01) when compared to a propensity score-matched control group. Patients with HA are at increased risk of sentinel adverse events following TSA compared to patients with normal serum albumin levels.

Porto-sinusoidal vascular disorder.

It is well established that portal hypertension can occur in the absence of cirrhosis, as reported in patients with immune disorders, infections and thrombophilia. However, similar histological abnormalities primarily affecting the hepatic sinusoidal and (peri)portal vasculature have also been observed in patients without portal hypertension. Thus, the term porto-sinusoidal vascular disorder (PSVD) has recently been introduced to describe a group of vascular diseases of the liver featuring lesions encompassing the portal venules and sinusoids, irrespective of the presence/absence of portal hypertension. Liver biopsy is fundamental for PSVD diagnosis. Specific histology findings include nodular regenerative hyperplasia, obliterative portal venopathy/portal vein stenosis and incomplete septal fibrosis/cirrhosis. Since other conditions including alcohol-related and non-alcoholic fatty liver disease, or viral hepatitis, or the presence of portal vein thrombosis may occur in patients with PSVD, their relative contribution to liver damage should be carefully assessed. In addition to histology and clinical diagnostic criteria, imaging and non-invasive tests such as liver and spleen stiffness measurements could aid in the diagnostic workup. The introduction of PSVD as a novel clinical entity will facilitate collaborative studies and investigations into the underlying molecular pathomechanisms encompassed by this term.

The Diagnostic Value of the Modified mSIS Score in Predicting Sentinel Axillary Lymph Node Positivity in Patients with Early-Stage Breast Cancer

Axillary lymph node metastasis is the most important prognostic factor in breast cancer. No method exists to diagnose the metastasis of the axillary lymph nodes before surgery. Sentinel lymph node biopsy is a procedure for axillary staging. Hematological parameters and systemic inflammation play a role in cancer metastasis. This study aims to evaluate the modified Systemic Inflammation Score (mSIS) score predicting sentinel axillary lymph node positivity in early breast cancer patients and to determine if there is a need to modify it. This is a retrospective study conducted in Ankara City Hospital General Surgery Department from March 2019 to July 2021. One hundred fifty-nine patients were analyzed according to age, albumin parameters, Thrombocyte, Lymphocyte and Monocyte count, histopathological type of cancer, and lymph node metastasis status. The collected information was entered into SPSS 24.0 program. Lymph node metastasis was detected in 51 of these 159 patients. Results showed no significant difference between the lymph node metastasis group and no lymph node metastasis group after applying the mSIS score to each group. This result is due to normal albumin levels in early breast cancer patients. Platalet lymphocyte ratio (PLR) is associated with lymph node metastasis in breast cancer. PLR is applied to mSIS score instead of albumin.The new modified early-stage breast cancer SIS(mebcSIS) was established as follows: Score 0: LMR ≥ 5.7 and PLR &lt; 141, Score 1: LMR &lt; 5.7 or PLR ≥ 141, Score 2: LMR &lt; 5.7 or PLR ≥ 141. The relationship between mebcSIS and LNM was statistically significant (p = 0.003). There is a positive correlation between mebcSIS score and lymph node metastasis in early breast cancer patients.