Serum Albumin Levels In Patients Research Articles

#1519 Nutritional impact of ketoanalogue supplementation with protein-restricted diets in advanced chronic kidney disease

Abstract Background and Aims The benefits and risks of a protein-restricted diet supplemented with ketoanalogues (KA) in patients with chronic kidney disease (CKD) are still being explored. Combining KA supplementation with a protein-restricted diet may potentially preserve the glomerular filtration rate (GFR) in CKD patients. However, concerns about protein-energy wasting and the nutritional benefits of KA supplementation remain uncertain. Previous systematic reviews have often included crossover or non-randomized studies and combined data from CKD and dialysis patients, potentially introducing heterogeneity when assessing the effects of KA supplementation in CKD patients. We aim to provide an updated and comprehensive assessment of the impact of combining KA supplementation with a protein-restricted diet on the nutritional status of advanced CKD patients compared to the effects of a protein-restricted diet alone. Method We conducted systematic literature searches of PubMed, Embase, Scopus, and Cochrane Library up to September 2023. We selected parallel-design randomized controlled trials comparing KA supplementation to a low- or very low-protein diet (VLPD) versus a low-protein diet (LPD) alone in adults with stages 3-5 CKD. Outcomes included serum albumin, triceps skinfold (TSF), and mid-arm muscle circumference (MAMC). Pooled estimates of effect measures were calculated using the random-effects model and presented as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Given the variation in CKD stages among the included studies, subgroup analyses were conducted based on baseline renal function (GFR < 20 vs. ≥ 20 mL/min/1.73 m²). To assess the robustness of our meta-analyses, we conducted sensitivity analyses by excluding studies with an in-trial follow-up duration of less than one year. Results We identified 13 trials with 974 participants and a median follow-up of 12 months. KA supplementation combined with an LPD or a VLPD significantly increased TSF compared to an LPD alone (SMD, 0.25; 95% CI, 0.04, 0.45; P = 0.02; Fig. 1). No significant differences were observed in serum albumin (SMD, 0.28; 95% CI, -0.05, 0.61; P = 0.10; Fig.) and MAMC (SMD, 0.10; 95% CI, -0.12, 0.32; P = 0.37; Fig. 1). KA supplementation significantly increased serum albumin in patients with a baseline GFR ≥ 20 mL/min/1.73 m² (SMD 0.52; 95% CI, 0.20, 0.84; P = 0.001), but not in those with a baseline GFR < 20 mL/min/1.73 m² (SMD, -0.04; 95% CI, -0.41, 0.34; P = 0.85), and this difference between the subgroups was statistically significant (P = 0.03; Fig. 2). Sensitivity analysis that excluded studies with an in-trial follow-up duration of less than one year yielded results similar to the main analysis, except that the difference in TSF between the intervention and control arms became nonsignificant. Conclusion In patients with stages 3-5 CKD, KA supplementation with a protein-restricted diet did not adversely affect nutritional status. These findings remained consistent in sensitivity analyses of RCTs with a follow-up of more than one year and in subgroup analyses based on baseline GFR. The addition of KAs to protein-restricted diets improved serum albumin levels in patients with a baseline GFR of ≥ 20 mL/min/1.73 m². Our analyses confirmed the efficacy and safety of KA supplementation on nutritional status in advanced CKD patients over a one year follow-up period.

Prognostic role of serum albumin levels in patients with chronic heart failure.

Hypoalbuminemia is common in heart failure (HF) patients; however, there are no data regarding the possible long-term prognostic role of serum albumin (SA) in the younger population with chronic HF without malnutrition. The aim of this study was to examine the long-term prognostic role of SA levels in predicting major adverse cardiac events (MACE) in middle-aged outpatients with chronic HF. In the present retrospective analysis, 378 subjects with HF were enrolled. MACE (non-fatal ischemic stroke, non-fatal myocardial infarction, cardiac revascularization or coronary bypass surgery, and cardiovascular death), total mortality, and HF hospitalizations (hHF) occurrence were evaluated during a median follow-up of 6.1years. In all population, 152 patients had a SA value < 3.5g/dL and 226 had a SA value ≥ 3.5g/dL. In patients with SA ≥ 3.5g/dL, the observed MACE were 2.1 events/100 patient-year; while in the group with a worse SA levels, there were 7.0 events/100 patient-year (p < 0.001). The multivariate analysis model confirmed that low levels of SA increase the risk of MACE by a factor of 3.1. In addition, the presence of ischemic heart disease, serum uric acid levels > 6.0mg/dL, chronic kidney disease, and a 10-year age rise, increased the risk of MACE in study participants. Finally, patients with SA < 3.5g/dl had a higher incidence of hHF (p < 0.001) and total mortality (p < 0.001) than patients with SA ≥ 3.5g/dl. Patients with chronic HF that exhibits low SA levels show a higher risk of MACE, hHF and total mortality.

Prognostic value of serum albumin level in patients with diffuse large B cell lymphoma.

To investigate the prognostic value of serum albumin (SA) levels before chemotherapy in patients with diffuse large B-cell lymphoma (DLBCL) after receiving chemotherapy. This is a retrospective study, and 127 patients with DLBCL including 71 males (55.9%) and 56 females (44.1%) were included. Patients' gender, age, Ann Arbor staging, eastern cooperative oncology group (ECOG) score, treatment options, international prognostic index, response rate, overall survival (OS), and progression-free survival (PFS) were obtained for statistical analysis. Univariate analysis showed that SA≤34 g/L, Ann Arbor III-IV, B symptoms, ECOG≥2, and bone marrow involvement suggest a poor prognosis in patients with DLBCL. Patients with persistent SA>34 g/L had significantly longer OS than patients with persistent SA≤34 g/L (P=0.020). Multivariate analysis showed that SA≤34 g/L (HR=0.48, 95% CI=0.26-0.90, P=0.022) and R-CHOP-like treatment regimen (HR=0.43, 95% CI=0.24-0.76, P=0.004) are independent factors that could affect the prognosis of patients with DLBCL. SA can be used as an indicator of prognosis in patients with DLBCL before the first chemotherapy. DLBCL patients with SA≤34 g/L are associated with short OS and poor prognosis, which may potentially provide guidance for the clinician to pay more attention to this population before the first chemotherapy.

The association between albumin and mortality in patients with acute kidney injury: a retrospective observational study

BackgroundWhile the association between decreased serum albumin (ALB) levels and increased risk of acute kidney injury (AKI) is well established, the risk of death among patients with AKI with low serum ALB levels is unclear. We aimed to evaluate the association between serum ALB levels in patients with AKI and mortality, and help guide their clinical management.MethodsThe included patients were those diagnosed with AKI and admitted to Zhejiang Provincial People's Hospital between January 2018 and December 2020. The clinical endpoint was all-cause mortality rate at 90-days and 1-year. Patients were divided into four groups according to the quartiles (Qs) of ALB measurements at admission. Cumulative survival curves were calculated using Kaplan–Meier analysis, and Cox proportional risk models were used to assess the association between serum ALB levels and 90-day and 1-year all-cause mortality.ResultsThis study included 740 patients with AKI. Patients with measured ALB values were classified into quartiles: Q1 ≤ 26.0 g/L (n = 188); Q2 = 26.1–30.5 g/L (n = 186); Q3 = 30.6–34.7 g/L (n = 183); Q4 ≥ 34.8 g/L (n = 183). Univariate analysis using Cox regression showed that for every 10 g/L increase in ALB, the 90-day and 1-year mortality decreased by 29%. Among the four subgroups, patients with lower ALB levels had a higher risk of death. After adjusting for demographics, comorbid conditions, inflammatory index, and medicine, the lowest ALB quartile (ALB < 26 g/L) was associated with increased risk of 90-day mortality (hazard ratio [HR], 1.76; 95% confidence interval [CI], 1.30 to 2.38, P < 0.001) and 1-year all-cause mortality (HR, 1.79; 95% CI, 1.33 to 2.41, P < 0.001).ConclusionsALB levels in patients with AKI were significantly correlated with prognosis, and the higher the level, the better the prognosis. Compared to patients with ALB ≥ 34.8 g/L, patients with 26.1 g/L < ALB ≤ 30.5 g/L had an increased risk of 90-day and 1-year all-cause mortality of approximately 40%, and patients with ALB ≤ 26.0 g/L had an increased risk of 90-day and 1-year all-cause mortality of approximately 76% and 79%, respectively.

Pharmacogenetic testing improves treatment responses in patients with PLA2R-related membranous nephropathy

To evaluate the value of pharmacogenetic testing for improving the efficacy and safety of treatment with cyclosporine, tacrolimus, and cyclophosphamide (CTX) for PLA2R-related membranous nephropathy and for determing individualized and precise treatment plans for the patients. A total of 63 patients with PLA2R-related membranous nephropathy hospitalized in the Department of Nephrology at our hospital from January, 2019 to October, 2021 were enrolled in this study. Thirty-three of the patients underwent pharmacogenetic testing before taking the immunosuppressive drugs selected based on the results of genetic screening for sensitive targets, and the other 30 patients were empirically given immunosuppressive drugs according to the guidelines (control group). The clinical efficacy and adverse effects of the immunosuppressive drugs were analyzed for all the patients. The two groups of patients were compared for demographic and biochemical parameters including 24-h urine protein, serum albumin, renal function, and serum anti-phospholipase A2 receptor antibody both before and at 3 months after the beginning of the treatment. Among the 33 patients undergoing pharmacogenetic testing, 51.5% showed a GG genotype for cyclosporine, and 61.6% had an AG genotype for tacrolimus; for CTX, 51.5% of the patients showed a homozygous deletion and 63.6% had an AA genotype. After treatment for 3 months, serum anti-phospholipase A2 receptor antibody, 24-h urine protein, and serum albumin levels were significantly improved in pharmacogenetic testing group as compared with the control group (P < 0.05). Individualized and precise administration of immunosuppressive drugs based on pharmacogenetic testing better controls proteinuria and serum antiphospholipase A2 receptor antibodies and increases serum albumin level in patients with PLA2R-related membranous nephropathy.

CRO infection and the Use of MRSA-active Medication for Prophylaxis affect the Prognosis of Patients with Hematological Malignancies after CAR-T Infusion

Carbapenem-resistant organisms (CRO) are a high priority issue because there are limited medications available to treat CRO infections, and these pathogens replicate rapidly in immunosuppressed patients, including those with hematological malignancy. Risk factors and prognosis of CRO infections after chimeric antigen receptor-modified T cells (CAR-T) therapy are unclear. This study was conducted to analyse the risk factors for CRO infection in patients with hematological malignancies following CAR-T therapy, and prognosis 1 year after CAR-T infusion. Patients who were diagnosed with hematological malignancies and treated with CAR-T therapy between June 2018 and December 2020 at our center were included. The case group consisted of 35 patients who developed CRO infections within 1 year of CAR-T infusion, and the control group comprised 280 patients who did not develop CRO infections. Shockingly, therapy failure occurred in 62.82% of CRO patients vs. 13.21% of the control group (P=0.000). Patients with CRO colonization (odds ratio [OR]=15.48, confidence interval [CI] (6.43-37.25), P=0.000) and hypoproteinemia (OR=2.84, CI (1.20-6.73), P=0.018) were susceptible to CRO infections. CRO infections (hazard ratio [HR]=4.40, CI (2.32-8.37), P=0.000), prophylaxis with combination regimens containing methicillin-resistant Staphylococcus aureus (MRSA)-active agents (HR=5.42, CI (2.65-11.11), P=0.000), and bacterial infections occurring within 30 days of CAR-T infusion (HR=1.97, CI (1.08-3.59), P=0.028) were risk factors for poor outcomes within 1 year. This study shows that prophylaxis of CRO infection should be a top priority in CAR-T therapy, the serum albumin level of patients should be dynamically monitored and interventions put in place if necessary, and caution is required in prophylaxis with anti-MRSA activity agents.

Involvement of spleen is associated with shorter survival in patients with angioimmunoblastic T cell lymphoma.

The prognosis of patients with angioimmunoblastic T cell lymphoma (AITL) remains dismal, with their 5-year overall survival (OS) and progression-free survival (PFS) rates of 32-41% and 18-38%, respectively. Spleen involvement occurs in a proportion of patients with AITL. But still, it is unclear whether spleen involvement impacts the prognosis of AITL patients. In this study, we aim to establish new prognostic indicators for the identification of high-risk patients to draft optimal treatment regimens. We collected and counted the clinical data of 54 patients with AITL treated with CHOP-based first-line chemotherapy regimen between 2010 and 2021 at Hubei Cancer Hospital and Hunan Cancer Hospital. In addition, all patients received PET-CT scan prior to receiving treatment. We performed univariate and multivariate analyses to assess the predictive role of tumor characteristics, laboratory, and radiographic data for the prognosis of AITL. We observed that PFS and OS are worse in patients with high ECOG scores, spleen involvement, and low serum albumin levels in patients with AITL. In univariate analysis, stage (HR 3.515 [1.142-10.822], p = 0.028) and spleen involvement (HR 8.378 [1.085-64.696, p = 0.042) were correlated with PFS in patients with AITL. Besides, stage (HR 3.439 [1.108-10.674], p = 0.033) and spleen involvement (HR 11.002 [1.420-85.254], p = 0.022) were significantly correlated with OS. Consistently, spleen involvement was correlated with OS (HR 16.571 [1.350-203.446], p = 0.028) and PFS (HR 10.905 [1.037-114.690], p = 0.047) in AITL patients in a multivariate analysis. This study demonstrates that spleen involvement might be used as a prognostic indicator for AITL patients.

Application of deep learning to predict the low serum albumin in new hemodialysis patients

BackgroundSerum albumin level is a crucial nutritional indicator for patients on dialysis. Approximately one-third of patients on hemodialysis (HD) have protein malnutrition. Therefore, the serum albumin level of patients on HD is strongly correlated with mortality.MethodsIn study, the data sets were obtained from the longitudinal electronic health records of the largest HD center in Taiwan from July 2011 to December 2015, included 1,567 new patients on HD who met the inclusion criteria. Multivariate logistic regression was performed to evaluate the association of clinical factors with low serum albumin, and the grasshopper optimization algorithm (GOA) was used for feature selection. The quantile g-computation method was used to calculate the weight ratio of each factor. Machine learning and deep learning (DL) methods were used to predict the low serum albumin. The area under the curve (AUC) and accuracy were calculated to determine the model performance.ResultsAge, gender, hypertension, hemoglobin, iron, ferritin, sodium, potassium, calcium, creatinine, alkaline phosphatase, and triglyceride levels were significantly associated with low serum albumin. The AUC and accuracy of the GOA quantile g-computation weight model combined with the Bi-LSTM method were 98% and 95%, respectively.ConclusionThe GOA method was able to rapidly identify the optimal combination of factors associated with serum albumin in patients on HD, and the quantile g-computation with DL methods could determine the most effective GOA quantile g-computation weight prediction model. The serum albumin status of patients on HD can be predicted by the proposed model and accordingly provide patients with better a prognostic care and treatment.

Correlation of serum albumin levels with the grading of esophageal varices

Background: Variceal bleed is one of the major complications seen in patients with cirrhosis of liver of various etiologies and endoscopy is a gold standard for its diagnosis which is an invasive procedure. There are other modalities of non-invasive methods to determine the degree of varices and estimation of serum albumin levels in one among them. Aims and Objectives: The aims of this study were as follows: (1) To measure serum albumin levels in patients with cirrhosis of liver and (2) to correlate serum albumin levels with grading of esophageal varices. Materials and Methods: A cross-sectional study was conducted on a total of 100 patients in Bangalore during the study period from October 2016 to September 2017. Case record form with follow-up chart was used to record the duration of disease, history of treatment and complications. Patients underwent biochemical investigations and endoscopy. The presence of varices and their size was obtained from endoscopy reports. Results: Study includes 100 patients that majority belonged to the age group 40–49 years (46%). Serum albumin levels of &lt;2.8 mg/dL was seen in high number of study subjects (76%). Forty patients had albumin levels of &lt;2.8 mg/dL with grade 3 OGD scopy, followed by 23 patients with Grade 1 esophagogastroduodenoscopy (OGD scopy). The association between albumin and OGD scopy grades was found to be significant (P=0.027). Conclusion: We conclude that low albumin levels predict higher grades of esophageal varices. It can identify the subset of patients who require prophylactic endoscopic management. Estimating serum albumin levels are non-invasive that can screen the patient for esophageal varices. Thus, this reduces the economic burden on the patients and the cost of management of esophageal varices.

Albumin-myosteatosis gauge as a novel prognostic risk factor in patients with non-metastatic colorectal cancer.

Myosteatosis and systemic inflammation are well-known prognostic factors in patients with colorectal cancer (CRC). The serum albumin level is a reflection of malnutrition and systemic inflammation, which in turn plays a key role in the development of myosteatosis. However, few studies have been conducted on these synergistic effects. This study aimed to examine the individual and synergistic effects of different prognostic markers related to skeletal muscle quality and serum albumin levels in patients with CRC. This study enrolled patients with stage I-III CRC who underwent surgical resection between July 2006 and February 2014. Skeletal muscle index (SMI) and skeletal muscle radiodensity (SMD) were calculated using computed tomography at the L3 level obtained within 2months prior to surgery. The albumin-myosteatosis gauge (AMG) was defined as SMD×albumin. Patients were divided into sex-specific quartiles (G1 to G4) according to the AMG, and analysis of variance for continuous variables and chi-square test for categorical variables were used to compare variables among quartiles. Cox proportional hazard models were constructed and integrated receiver operating characteristic curve (iAUC) analysis was used to compare the prognostic performance of SMD, albumin and AMG. Among the 906 participants, the median (interquartile) age was 64 (55-72) years, and 365 (40.3%) were female. AMG was significantly correlated with the occurrence of complications, albumin level, SMI and SMD (all P<0.001). Overall survival (OS) differed significantly according to the AMG group, with 5-year OS for G1-G4 being 73.4%, 86.2%, 91.1% and 95.5%, respectively (P<0.0001). Although SMI, SMD, albumin and AMG were all significant individual prognostic markers of OS in the univariable analysis, AMG remained the only independent prognostic factor in the multivariable analysis (G1 vs. G2, P=0.045, G1 vs. G3, P=0.005, G1 vs. G4, P<0.001, respectively). The iAUC value of AMG [0.681, 95% confidence interval (CI)=0.638-0.723] was superior to that of SMD (0.610, 95% CI=0.566-0.654) (bootstrap iAUC mean difference=0.071, 95% CI=0.034-0.106), SMI (0.551, 95% CI=0.511-0.594) (bootstrap iAUC mean difference=0.129, 95% CI=0.076-0.181) and albumin (0.627, 95% CI=0.585-0.668) (bootstrap iAUC mean difference=0.053, 95% CI=0.010-0.098). In patients with stage I-III CRC, AMG is a meaningful predictor of survival, with superior prognostic value compared to SMI, SMD or albumin alone. Further studies are needed to determine their significance in different ethnic groups.

Effects of Serum Albumin Level in Section Lower vs Upper Extremity Surgery: A Hospital-based Retrospective Study

Introduction: Trauma and major surgery often lead to low serum albumin level in patients. Several studies have been reported showing depressed serum albumin level in upper, lower extremity and other major surgery. Metabolic stress response from major surgical interventions and prolonged immobility are primarily responsible for low serum albumin level in these patients. Aim: To investigate the preoperative and postoperative serum albumin levels in patients who underwent extremity surgery and compare the changes in albumin levels between those who underwent upper extremities surgery versus lower extremities surgery. Materials and Methods: This was a hospital-based retrospective study, including 120 patients, who presented to the Emergency Department of Surgery and Orthopaedics, in Deben Mahata Government Medical College and Hospital, Purulia, West Bengal, India, due to trauma included in the present study (on and from November 30 2018 to November 30 2021). All the patients underwent either lower or upper extremity surgery (Group 1 and Group 2, respectively) by orthopaedic surgeons and were consecutively selected regardless of their ages. The serum albumin levels at the time of admission and on the third day after surgery were obtained from the hospital patient records. Continuous variables were expressed as mean±standard deviation. The normality test of the numerical variables using Kolmogorov-Smirnov test. Results: Mean age of population in the upper extremities surgery group was 38.8 years vs 30.5 years in the lower extremities. A statistically significant difference in the preoperative and postoperative serum albumin levels was found in both groups (p&lt;0.05). Moreover, the mean difference between preoperative and postoperative serum albumin levels was found to be significantly higher in the lower extremity group (1.52±0.32 gm/dL) than in the upper extremity group (0.95±0.39 g/dL) (p&lt;0.05) and the coefficient of correlation between these two groups r&gt; 0.7 indicating significant difference between albumin levels in two groups. Conclusion: This study revealed that both upper and lower extremity surgeries caused hypoalbuminemia. The study was novel in finding that lower extremity surgery caused more severe hypoalbuminemia in the patients compared with the patients of upper extremity surgery. A correlation study done between two groups and was found to be significant with p-value &lt;0.05 and r value&gt; 0.7. The reason for this significant difference was the longer duration of lower extremity surgery requiring more fluid support during the surgery and resultant increased metabolic stress.

Disease-Specific Treatment For Primary Membranous Nephropathy: The Role of Monoclonal Antibodies

Primary Membranous Nephropathy is an autoimmune disease caused by the deposition of Immunoglobulin G and complement components on the subepithelial layer of the glomerular capillary wall. It affects 5-10 patients per million population and is the second cause of nephrotic syndrome in adults after diabetic kidney disease. For decades steroids and non-specific immunosuppressive medications have been advocated as a therapeutic option for patients with membranous nephropathy at increased risk of kidney failure because of persistent nephrotic syndrome. These medications, however, have major and potentially fatal adverse effects that offset their potential benefits and should be abandoned. The discovery of nephritogenic autoantibodies against podocyte M-type phospholipase A2 receptor (PLA2R) and thrombospondin type-1 domain-containing protein 7A (THSD7A) antigens provided a clear pathophysiological rationale for interventions specifically targeting B cell lineages to prevent antibody production and subepithelial deposition. The first-in-class anti-CD20 monoclonal antibody rituximab is safe and achieves remission in approximately two-thirds of patients with nephrotic membranous nephropathy. In PLA2R-related disease, remission is invariably preceded by depletion of anti PLA2R autoantibodies and relapse by their re-emergence into the circulation. Because of its superior risk/benefit profile as compared to non-specific immunosuppressive therapy, rituximab is now first-line therapy for patients with membranous nephropathy at risk of kidney failure. Novel monoclonal antibodies targeting CD20 cells (such as ofatumumab and obinutuzumab) and their differentiation (belimumab) or targeting long-living antibody producing CD38 memory cells (daratumumab, felzartamab) along with proteasome inhibitors such as bortezomib are being evaluated for the treatment of nephrotic patients with membranous nephropathy who are resistant or intolerant to rituximab. Complement inhibitor therapy might serve to stop the glomerular inflammatory process until the benefits of these medications become effective. Thus, major advances in the understanding of the mechanisms of membranous nephropathy have led to novel treatment perspectives. The integrated evaluation of serum autoantibody titer and proteinuria, together with serum albumin levels in patients with overt nephrotic syndrome, could guide diagnosis of membranous nephropathy and individually tailored treatment protocols. The introduction of monoclonal antibodies targeting disease-specific mechanisms will pave the way for a novel therapeutic paradigm based on the principle of precision medicine and personalized therapy.

The role of cardiometabolic risk factors and endothelial dysfunction in serum albumin levels of patients with COVID-19.

The role of cardiometabolic risk factors and endothelial dysfunction in serum albumin levels of patients with COVID-19.

Correlation of Sodium and Serum Albumin Levels with the Severity of Acute Ischemic Stroke

Management of acute ischemic stroke patients based on their severity in emergency services is critical. One of the easy, fast, and affordable biochemical markers is serum sodium and albumin, which correlate with the severity of acute ischemic stroke. This research aimed to analyze the correlation of serum sodium and albumin levels with the severity of acute ischemic stroke. This retrospective study used medical record data of 165 acute ischemic stroke patients for the period January 2018-April 2021 at Dr. Wahidin Sudirohusodo Hospital, Makassar. Patients were classified according to the degree of mild, moderate, or severe stroke through the NIHSS score. Examination of serum sodium was done by Electrolyte Analyzer NOVA 5 and albumin with ABX Pentra 400. Data normality test Kolmogorov-Smirnov. The statistical test used the Kruskal-Wallis, Mann-Whitney, and Spearman (significant if p&lt;0.05). There was a negative correlation between serum albumin levels and the severity of stroke patients (p&lt;0.001; r= -0.327). There was no significant association between serum sodium and ischemic stroke severity. There was a statistically significant difference in serum albumin levels in patients with mild and moderate stroke (p=0.001), mild and severe (p=0.001). Albumin correlates the outcome of acute ischemic stroke patients (p&lt;0.001), cut-off ≤ 3.25 g/dL (sensitivity 66.7%, specificity 50%). Hypoalbuminemia exacerbates cytotoxic edema by causing water and ions to cross the blood-brain barrier to the astrocytes resulting in further neuron damage. Albumin has a correlation with the NIHSS score (p&lt;0.001; r= -0.327). The lower the albumin level, the higher the NIHSS score, indicating the ischemic stroke severity.

Trajectory of Serum Albumin Prior to Death in Patients Receiving Hemodialysis

Although some clinical expert guidelines recommend regular monitoring of serum albumin levels in patients undergoing maintenance hemodialysis, little is known about the serum albumin trajectory patterns over time, and it is unclear how the trajectory change before death. We performed this retrospective study using data from 421 patients receiving hemodialysis in a dialysis facility. We divided patients into died and survived groups according to whether they died during the observation period. To compare the albumin trajectories during the observation period between the died and survived groups, linear mixed-effect models and a backward timescale from the year of death or study end were used. During the observation period (median, 5.1years; maximum, 8.4years), 115 patients receiving dialysis died. The serum albumin level showed steeper decline 3years before death in the died group than in the survived group. The difference in albumin between the died and survived groups became apparent 3years before death (difference, 0.08g/dL; 95% confidence interval, 0.00-0.15g/dL; P=.04), and the difference widened over time (difference at 1year before death, 0.24g/dL; 95% confidence interval, 0.14-0.33g/dL; P<.001). Furthermore, in an analysis of albumin trajectories according to cause of death, the albumin level showed a downward trend regardless of the cause of death. The serum albumin trajectory differed between patients undergoing hemodialysis who died and who survived, supporting the importance of monitoring the albumin trajectory in clinical practice.

Comparison of Hematological Parameters Between First-Episode Schizophrenia and Anti-NMDAR Encephalitis.

Background: First-episode schizophrenia (FES) and anti-NMDAR encephalitis are different disorders with similar psychiatric symptoms, and both diseases are associated with the inflammatory system. In this study, we compared hematological parameters and inflammation ratios in anti-NMDAR encephalitis, FES, and healthy control. Methods: We enrolled 106 patients (53 FES patients and 53 anti-NMDAR encephalitis patients) and 59 healthy controls. The values of the neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), monocyte–lymphocyte ratio (MLR), and systemic immune-inflammation index (SII) were used to evaluate inflammation. Other parameters such as the white blood cell (WBC), platelet (PLT), uric acid (UA), total bilirubin (TBIL), total bile acid (TBA), and serum albumin counts were also used to compare inflammation ratios between these two diseases. Results: SII, NLR, PLR, MLR, and serum albumin levels were statistically significantly different between these three groups (p < 0.05). The values of SII, NLR, PLR, and MLR were significantly higher in the anti-NMDAR encephalitis group than those in the FES group (p < 0.05), and the values in both diseases were more increased than those in HC (p < 0.05). The serum albumin level was significantly lower in anti-NMDAR encephalitis than in FES (p < 0.05). WBC, neutrophil, lymphocyte, and monocyte counts showed significantly higher levels in the anti-NMDAR encephalitis group and FES group separately (p < 0.05). Other parameters like TBA, TBIL, and UA showed no difference between groups. Conclusion: In summary, this is a relatively new study that is innovative by comparing some inflammation markers of peripheral blood in two diseases with clinically psychotic symptoms. These two diseases are related to the inflammatory system, proving that NMDAR dysfunction is related to psychotic symptoms. Besides, NLR, PLR, MLR, and serum albumin can be used as biomarkers to distinguish the two diseases. The serum albumin level in patients with anti-NMDAR encephalitis was lower than that in patients with schizophrenia.

A study of serum albumin levels in acute coronary syndrome and its correlation with clinical outcome

Background: Coronary artery disease (CAD) is major cause of death and mortality in the developed world. Coronary atherosclerotic disease involves the epicardial coronary arteries and may manifest as an acute or chronic coronary syndrome. Acute coronary syndrome (ACS) arises from atherosclerotic plaque rupture leading to coronary thrombosis and/or spasm.Methods: The present study was conducted in department of medicine, Guru Nanak Dev hospital attached to government medical college, Amritsar from May 2021 to December 2021. This was a prospective observational study in which a total of 50 patients of ACS were enrolled. Serum albumin levels of the patients were recorded and clinical outcomes based on the albumin levels were compared between the patients.Results: The patients with low serum albumin levels had worse outcomes. The mean serum albumin level of STEMI and NSTEMI patients in hypoalbuminemia group was 2.88±0.11 g/dl and 3.15±0.26 g/dl (p=0.047). The mean serum albumin level of patients having mortality in hypoalbuminemia group was 2.87±0.06 g/dl and those who didn’t have mortality was 3.19±0.21 g/dl (p=0.013). The mean serum albumin level of patients developing new onset heart failure in hypoalbuminemia group was 2.85±0.06 g/dl and those not developing had 3.11±0.19 g/dl (p=0.021).Conclusions: We conclude that ACS patients presenting with hypoalbuminemia are more likely to develop worse outcomes in the form of heart failure, cardiogenic shock and mortality. ACS patients presenting with low serum albumin levels have more chances of developing STEMI.

Management of Psychiatric Disorders in Patients with Chronic Kidney Diseases.

Management of Psychiatric Disorders in Patients with Chronic Kidney Diseases.

Albumin Description of Continuous Ambulatory Peritoneal Dialysis (CAPD) Patients in Sardjito Hospital Yogyakarta

Albumin profile is an important sign of nutritional status as a quality-of life parameter, whereas hypoalbuminemia has been shown to be associated with a high mortality rate for patients with End Stage Renal Disease (ESRD) undergoing dialysis including CAPD. The study was conducted to determine serum albumin levels in patients with ESRD undergoing CAPD therapy. The study was conducted in a cross-sectional manner on ESRD patients who were still actively undergoing CAPD in the outpatient Installation of Dr. Sardjito Hospital Yogyakarta until November 2018. Subjects were examined for serum albumin levels. There were 57 research subjects with the category of albumin levels &lt;3.5 g / dL as many as 19 (33.3%), between 3.5-4.0 g / dL as many as 27 (47.3%) and albumin levels&gt; 4.0 g / dL of 11 (19.3%). There were no significant differences in all age groups, BMI and duration of CAPD. Albumin profile can be an independent parameter of quality of life and even a predictor of mortality in CAPD patients because it does not depend on age group, BMI and length of CAPD

Clinical value of serum albumin level in patients with non-small cell lung cancer and anaplastic lymphoma kinase (ALK) rearrangement.

There are few data on the clinical value of serum albumin (Alb) level as a prognostic indicator in advanced non-small cell lung cancer (NSCLC) patients with positive anaplastic lymphoma kinase (ALK) rearrangement. Thus, we retrospectively analyzed the clinicopathological features of advanced, ALK-positive NSCLC patients diagnosed and treated at our institution to investigate the effects of pretreatment serum Alb on outcome in this patient setting. We selected 261 consecutive patients with newly diagnosed pathologically or cytologically confirmed NSCLC harboring ALK rearrangement between May 2016 and February 2018. The target-independent and dependent variables were Serum albumin level measured in patients before anticancer treatment and progression-free survival (PFS). Pre-treatment serum Alb levels and demographic, clinical, and histological characteristics, as well as outcome variables were recorded and analyzed. Serum albumin level was estimated before treatment and at every visit. The pretreatment and the lowest serum albumin level during treatment were recorded. The mean pretreatment Alb level was 42.185 g/L. Before the treatment initiation, low Alb level (<40 g/L) was measured in 74 (28.4%) patients and normal Alb (≥40 g/L) was measured in 187 (71.6%) participants. Low pretreatment Alb (<40 g/L) was more highly prevalent in those with pleural effusion (P=0.013). Pretreatment hypoalbuminemia was significantly associated with shorter progression-free survival (PFS) [8.0 months, 95% confidence interval (CI): 4.56-11.44 vs. 12.0 months, 95% CI: 9.85-14.15; P=0.046]. Crizotinib-treated participants had a significantly prolonged PFS compared to those treated with chemotherapy, regardless of Alb level [normal Alb level: 19.0 (95% CI: 12.72-25.28) vs. 8.0 (95% CI: 6.22-9.78), P<0.001; low Alb level: 12.0 months (95% CI: 10.13-13.87) vs. 6.0 months (95% CI: 2.95-9.05), P=0.006]. Multivariate analyses indicated that poor Eastern Cooperative Oncology Group performance status (ECOG PS) [hazard ratio (HR) =1.66; 95% CI: 1.16-2.38; P=0.005] and presence of pleural effusion (HR =2.43; 95% CI: 1.55-3.82; P<0.001) were significantly independent predictive factors for PFS in ALK-positive NSCLC. Pretreatment hypoalbuminemia is associated with poor outcome of NSCLC patients harboring ALK rearrangement. However, the role of the pretreatment serum Alb level as predictive biomarker requires further investigation.