Severe Hypoalbuminemia Research Articles

Hypoalbuminemia affects one third of acute pancreatitis patients and is independently associated with severity and mortality

The incidence and medical costs of acute pancreatitis (AP) are on the rise, and severe cases still have a 30% mortality rate. We aimed to evaluate hypoalbuminemia as a risk factor and the prognostic value of human serum albumin in AP. Data from 2461 patients were extracted from the international, prospective, multicentre AP registry operated by the Hungarian Pancreatic Study Group. Data from patients with albumin measurement in the first 48 h (n = 1149) and anytime during hospitalization (n = 1272) were analysed. Multivariate binary logistic regression and Receiver Operator Characteristic curve analysis were used. The prevalence of hypoalbuminemia (< 35 g/L) was 19% on admission and 35.7% during hospitalization. Hypoalbuminemia dose-dependently increased the risk of severity, mortality, local complications and organ failure and is associated with longer hospital stay. The predictive value of hypoalbuminemia on admission was poor for severity and mortality. Severe hypoalbuminemia (< 25 g/L) represented an independent risk factor for severity (OR 48.761; CI 25.276–98.908) and mortality (OR 16.83; CI 8.32–35.13). Albumin loss during AP was strongly associated with severity (p < 0.001) and mortality (p = 0.002). Hypoalbuminemia represents an independent risk factor for severity and mortality in AP, and it shows a dose-dependent relationship with local complications, organ failure and length of stay.

Сравнение основных факторов риска формирования сепсиса у пациентов с неспецифическим остеомиелитом позвоночника и туберкулезным спондилитом

Background Chronic osteomyelitis is characterized by changes in bone structure of different extent and severity that are poorly defined. The objective was to determine the incidence of sepsis in patients with non-specific osteomyelitis of the spine (NOS) and tuberculous spondylitis (TS), and compare the main risk factors contributing to the occurrence. Material and methods Treatment was produced for 82 patients with verified sepsis that accounted for 8.6 % of all patients operated for infectious spondylitis (IS). Patients were diagnosed with NOS (n = 48, Group 1) and TS (n = 34, Group 2). Microflora in the blood was detected in half (n = 39, 47.5 %) of the patients with procalcitonin test performed in all cases. Results IS patients were diagnosed with chronic pulmonary diseases (45/58.0 %), renal diseases (32/39.0%), chronic stomach and duodenal diseases (23/28.0 %), viral hepatitis (18/21.9 %), cardiovascular diseases (23/28.0 %), diabetes mellitus (12/14.6 %), etc. Factors contributing to the development of sepsis in TS patients were chronic pulmonary diseases (p = 0.024, χ2 = 7.132), liver cirrhosis (p = 0.036, χ2 = 6.458) and HIV (p = 0.035, χ2 = 6.158). Discussion Risk factors for septic conditions in IS patients included age over 70 years, severe neurological deficit, hypoalbuminemia, cachexia (BMI &lt; 17 kg/m2), obesity (BMI &gt; 35 kg/m2), HIV and severe comorbidities (ASA 3 or ASA 4). The favorable outcome of the disease occurred due to early detection of sepsis based on SOFA score and timely initiated pathogenetic treatment.

Serum albumin level is associated with mycophenolic acid concentration in children with idiopathic nephrotic syndrome.

Mycophenolate mofetil is effective for the treatment of pediatric idiopathic nephrotic syndrome (INS). The dosage of mycophenolate mofetil is adjusted according to the serum concentration of mycophenolic acid (MPA). Kidney function or cyclosporine (CsA) concentrations affect serum MPA levels. However, few studies have focused on the association between serum concentrations of MPA and albumin. This retrospective observational study aimed to evaluate the relationship between the serum concentrations of MPA and albumin in INS children. Subjects were children with INS who underwent the therapeutic drug monitoring of CsA and MPA. We obtained the serum albumin (sAlb) concentration, estimated glomerular filtration rate (eGFR), age, and MPA and CsA areas under concentration-time curves from 0 to 12h (AUC0-12). Multiple linear regression analysis and generalized estimating equations were performed to predict values for MPA AUC0-12. We obtained information for 51 INS children with 261 MPA AUC0-12 measurements. The standardized regression coefficients of sAlb, eGFR, CsA AUC0-12, and age were 0.54, - 0.21, - 0.07, and 0.04, respectively. Furthermore, MPA AUC0-12 levels positively correlated with sAlb concentrations (p < 0.001) and were inversely correlated with eGFR values (p = 0.005) but not with CsA AUC0-12 (p = 0.24) and age (p = 0.65).Conclusion: Serum albumin concentration was strongly associated with total MPA concentration compared with kidney function or CsA values. Although patients with INS may have a low serum concentration of total MPA in the presence of low sAlb concentration, close attention should be paid to the interpretation of the low MPA values. What is Known: • The dosage of mycophenolate mofetil is adjusted according to the serum concentration of total mycophenolic acid. • Kidney function, cyclosporin concentrations, or serum albumin concentrations influence serum mycophenolic acid levels. What is New: • Serum albumin concentration is more strongly associated with total mycophenolic acid concentration than kidney function or cyclosporin values. • In children with nephrotic syndrome, the total mycophenolic acid concentration may not increase in the presence of severe hypoalbuminemia.

A novel model of nephrotic syndrome results from a point mutation in Lama5 and is modified by genetic background

Nephrotic syndrome is characterized by severe proteinuria, hypoalbuminaemia, edema and hyperlipidaemia. Genetic studies of nephrotic syndrome have led to the identification of proteins playing a crucial role in slit diaphragm signaling, regulation of actin cytoskeleton dynamics and cell-matrix interactions. The laminin α5 chain is essential for embryonic development and, in association with laminin β2 and laminin γ1, is a major component of the glomerular basement membrane, a critical component of the glomerular filtration barrier. Mutations in LAMA5 were recently identified in children with nephrotic syndrome. Here, we have identified a novel missense mutation (E884G) in the uncharacterized L4a domain of LAMA5 where homozygous mice develop nephrotic syndrome with severe proteinuria with histological and ultrastructural changes in the glomerulus mimicking the progression seen in most patients. The levels of LAMA5 are reduced in vivo and the assembly of the laminin 521 heterotrimer significantly reduced in vitro. Proteomic analysis of the glomerular extracellular fraction revealed changes in the matrix composition. Importantly, the genetic background of the mice had a significant effect on aspects of disease progression from proteinuria to changes in podocyte morphology. Thus, our novel model will provide insights into pathologic mechanisms of nephrotic syndrome and pathways that influence the response to a dysfunctional glomerular basement membrane that may be important in a range of kidney diseases.

Clinical manifestations, laboratory profile and outcomes of dengue virus infection in hospitalised older patients.

Due to an ageing population, dengue among older patients is encountered more frequently in many countries. Our study aimed to explore the clinico-laboratory parameters and outcomes among dengue-infected older patients in comparison with younger patients. This retrospective chart review involved dengue patients with dengue non-structural protein 1 (NS1) antigen positivity admitted to a tertiary hospital in Malaysia from January to July 2015. A comparison was made between older people (aged ≥60 y) and others. Among 406 dengue patients, 43 (10.6%) were older people. Older dengue patients were less likely to present with persistent vomiting (adjusted OR [AOR] 0.247, 95% CI 0.093 to 0.656, p=0.005), while restlessness and confusion were more common at presentation (AOR 3.356, 95% CI 1.024 to 11.003, p=0.046). Older patients had significantly lower albumin upon admission (38 vs 40 g/L, p=0.036) and during hospital stay (35 vs 37 g/L, p=0.015). Compared with younger patients, older patients were more likely to have experienced nadir platelet counts of <50×109/L (AOR 2.897, 95% CI to 1.176 to 7.137, p=0.021). They were also more likely to require an extended hospital stay (AOR 3.547, 95% CI 1.575 to 7.986, p=0.002). Diagnosis of dengue in older people may be challenging because of atypical presentations. Increased vigilance is necessary as there is an increased tendency to develop severe thrombocytopenia, hypoalbuminemia and prolonged hospitalisation in older people.

Late complications of biliopancreatic diversion in an older patient: a case report

BackgroundIn the mid-seventies, biliopancreatic diversion became popular as weight-loss surgery procedure. This bariatric procedure combines distal gastric resection and intestinal malabsorption, leading to greater weight loss and improvement of co-morbidities than other bariatric procedures. Nowadays, biliopancreatic diversion has become obsolete due to the high risk of nutritional complications. However, current patients with biliopancreatic diversions are aging. Consequently, geriatricians and general practitioners will encounter them more often and will be faced with the consequences of late complications.Case presentationA 74-year old female presented with weakness, recurrent falls, confusion, episodes of irresponsiveness, anorexia and weight loss. Her medical history included osteoporosis, herpes encephalitis 8 years prior and a biliopancreatic diversion (Scopinaro surgery) at age 52. Cerebral imaging showed herpes sequelae without major atrophy. Delirium was diagnosed with underlying nutritional deficiencies. Biochemical screening indicated vitamin A deficiency, vitamin E deficiency, zinc deficiency and severe hypoalbuminemia. While thiamin level and fasting blood glucose were normal. However, postprandial hyperinsulinemic hypoglycemia was observed with concomitant signs of confusion and blurred consciousness. After initiating parenteral nutrition with additional micronutrient supplementation, a marked improvement was observed in cognitive and physical functioning.ConclusionsLong-term effects of biliopancreatic diversion remain relatively underreported in older patients. However, the anatomical and physiological changes of the gastrointestinal tract can contribute to the development of metabolic and nutritional complications that may culminate in cognitive impairment, functional decline and delirium. Therefore, it is warranted to evaluate the presence of metabolic disturbances and nutritional complications in older patients after biliopancreatic diversion.

Severe Hypoalbuminemia at Admission Is Strongly Associated with Worse Prognosis in Older Adults with SARS-CoV-2 Infection.

Serum albumin levels have been associated with prognosis in several conditions among older adults. The aim of this study is to assess the prognostic value in mortality of serum albumin in older adults with SARS-CoV-2 infection. Methods. Cohort observational study with consecutive older-adults (≥65 years old), with confirmed SARS-CoV-2 infection admitted to a university hospital between March–May 2020. A logistic regression model was fitted to assess the impact of albumin levels on in-hospital mortality adjusted by potential confounders. Results. Among a total of 840 patients admitted to the hospital, 405 (48%) were older adults with a total of 92 deaths (23%) among them. Those who died were older, had more comorbidities, higher inflammation status and lower levels of serum albumin at admission [3.10 g/dL (0.51) vs. 3.45 g/dL (0.45); p < 0.01. Serum albumin levels at admission were negatively correlated with inflammatory markers such as C-Reactive protein (Pearson Coeff −0.4634; p < 0.001) or IL-6 (Pearson’s Coeff −0.244; p = 0.006) at admission but also to other clinical outcomes such time to clinical stability (Pearson’s Coeff −0.259; p < 0.001). Severe hypoalbuminemia associated with increased risk of mortality was defined as ≤3 g/dL at admission according to the AUC/ROC analysis (0.72 95% CI 0.63–0.81) In a multivariate logistic regression model adjusting by age, inflammation, comorbidities and severity at admission severe hypoalbuminemia was a strong predictor of in-hospital mortality (OR 2.18 95% CI 1.03–4.62; p = 0.039). Conclusion. Severe hypoalbuminemia with ≤3 g/dL is an independent risk factor for mortality among older adults with SARS-CoV-2 infection. There is a consistent correlation between albumin levels and inflammatory biomarkers. Further studies are needed to determine whether the supplementation of albumin as coadjuvant treatment will have a positive impact on the prognosis of this infection.

Una “crisi” celiaca

The authors present the case of a 3-year-old child with severe diarrhoea, hypoalbuminaemia, hypogammaglobulinaemia and anaemia eventually diagnosed as coeliac. The clinical features of the so-called coeliac crisis are discussed.

Predictive value of hypoalbuminemia and severe hypoalbuminemia in oncologic spine surgery

Study designRetrospective review of a prospectively collected national database. ObjectiveTo evaluate the predictive value of hypoalbuminemia on outcomes in surgical spine oncology patients. Summary of background dataIt is well documented that patients with hypoalbuminemia (albumin <3.5) have significantly higher rates of surgical morbidity and mortality than patients with normal albumin (>3.5 g/dl). We evaluated outcomes for metastatic oncologic spine surgery patients based on pre-operative albumin levels. Materials and methodsPatients who underwent surgery for metastatic spine disease were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2006 to 2016. Three groups were established: patients with normal albumin (>3.5 g/dl), mild hypoalbuminemia (2.6 g/dl – 3.4 g/dl), and severe hypoalbuminemia (<=2.5 g/dl). A multivariate analysis was used to assess the association between albumin levels and mortality within 30 days of surgical intervention. ResultsA total of 700 patients who underwent surgery for metastatic spinal disease and had pre-operative albumin levels available were identified; 64.0% had normal albumin (>3.5 g/dl), 29.6% had mild hypoalbuminemia, and 6.4% had severe hypoalbuminemia. The overall 30-day mortality was 7.6% for patients with normal albumin, 15.9% for patients with mild hypoalbuminemia, and 44.4% for patients with severe hypoalbuminemia. On multivariate analysis, patients with mild hypoalbuminemia (OR 1.7 95% CI: 1.0–3.0 p = 0.05) and severe hypoalbuminemia (OR 6.2 95% CI: 2.8–13.5 p < 0.001) were more likely to expire within 30 days compared to patients with preoperative albumin above 3.5 g/dl. ConclusionIn this study, albumin level was found to be an independent predictor of 30-day mortality in patients who underwent operative intervention for metastatic spinal disease. Patients with severe hypoalbuminemia had a 7-fold increased risk when compared with those who had normal albumin. While these findings need to be validated by future studies, we believe they will prove useful for preoperative risk stratification and surgical decision-making

Clinical and laboratory factors associated with nosocomial pneumonia in adult patients in the internal medicine department of a national hospital in Peru: A case-control study.

To determine how clinical and laboratory factors were associated with nosocomial pneumonia in adult patients hospitalized in an internal medicine department. We conducted a retrospective unmatched case-control study. We recorded clinical and epidemiological data from patients discharged from an internal medicine department of a Peruvian reference hospital, the Hospital Nacional Arzobispo Loayza, between 2016 and 2018. Bivariate and multivariate analyses (using logistic regression models) were performed to obtain crude and adjusted odds ratios with 95% confidence intervals. A P value < 0.05 was considered significant. We calculated the population attributable fraction of the significant variables. We analyzed 138 cases and 200 controls, with a mean age of 72.6 ± 17.8 years (21 to 104) for cases and 71.7 ± 15.3 years (19 to 98) for controls. The multivariate analysis indicated that severe anemia (adjusted odds ratio 9.0, confidence interval 95% 1.9 to 43.1, P = 0.01), severe hypoalbuminemia (adjusted odds ratio 4.0, confidence interval 95% 1.2 to 13.8, P = 0.03), altered state of consciousness (adjusted odds ratio 3.6, confidence interval 95% 1.6 to 8.2, P = 0.00), and prior use of antibiotics (adjusted odds ratio 6.3, confidence interval 95% 2.7 to 14.5, P = 0.00) were significantly associated with nosocomial pneumonia. The population attributable fraction found were 41.8% for altered state of consciousness, 33.2% for severe anemia, and 36.3% for severe hypoalbuminemia. Clinical and laboratory risk factors associated with nosocomial pneumonia development in adult patients hospitalized in an internal medicine department were severe anemia, severe hypoalbuminemia, altered consciousness, and previous use of antibiotics.

Use of albumin : State of the art

Die Saline vs. Albumin Fluid Evaluation (SAFE) Studie hat gezeigt, dass der Einsatz von Albumin als Infusionslösung im Bereich der Volumentherapie fast überall sicher ist. Eine Ausnahme stellt hypoonkotisches Albumin beim Schädel-Hirn-Trauma dar. Während für Patientinnen und Patienten mit Leberzirrhose klare Indikationen existieren, fehlen für andere Einsatzgebiete noch große Studien, die einen klinisch relevanten Vorteil jenseits der hämodynamischen Wirksamkeit zweifelsfrei zeigen konnten und damit einen breiteren Einsatz rechtfertigen würden. Bei der „Large-volume“-Parazentese, der spontanen bakteriellen Peritonitis, aber auch beim hepatorenalen Syndrom ist der Einsatz von Albumin aufgrund eines klinischen Benefits in randomisierten kontrollierten Studien klar empfohlen und etabliert. Beim septischen Schock kann ein Einsatz von Albumin in Erwägung gezogen werden, wobei sich zwei große Studien zu dieser Fragestellung in Deutschland und Italien noch in der Rekrutierungsphase befinden. Für viele Einsatzgebiete in der Volumentherapie gilt, dass Albumin vor allem dann eingesetzt werden kann, wenn andere Maßnahmen zur hämodynamischen Stabilisierung bereits ausgeschöpft sind. Das gilt sowohl für die Volumengabe bei Hypovolämie als auch für das konservative Volumenmanagement einschließlich der sog. Deresuscitation-Phase. Inwieweit die Korrektur einer ausgeprägten Hypoalbuminämie durch Gabe von exogenem Albumin auch das schlechtere Outcome solcher Patientinnen und Patienten verbessert, ist ebenfalls Teil laufender Studien. Auf dem Weg zu einem Mehr an individualisierter Therapie kann in Zukunft die Hypoalbuminämie bei Entscheidungen für oder gegen einen Einsatz von intravenösen Albuminlösungen in der Volumentherapie eine wichtige Rolle einnehmen.

Risk factors, predictions, and progression of acute kidney injury in hospitalized COVID-19 patients: An observational retrospective cohort study.

Studies have shown that acute kidney injury (AKI) occurrence post SARS-CoV-2 infection is complex and has a poor prognosis. Therefore, more studies are needed to understand the rate and the predications of AKI involvement among hospitalized COVID-19 patients and AKI's impact on prognosis while under different types of medications. This study is a retrospective observational cohort study conducted at Bahrain Defence Force (BDF) Royal Medical Services. Medical records of COVID-19 patients admitted to BDF hospital, treated, and followed up from April 2020 to October 2020 were retrieved. Data were analyzed using univariate and multivariate logistic regression with covariate adjustment, and the odds ratio (OR) and 95% confidence (95% CI) interval were reported. Among 353 patients admitted with COVID-19, 47.6% developed AKI. Overall, 51.8% of patients with AKI died compared to 2.2% of patients who did not develop AKI (p< 0.001 with OR 48.6 and 95% CI 17.2-136.9). Besides, deaths in patients classified with AKI staging were positively correlated and multivariate regression analysis revealed that moderate to severe hypoalbuminemia (<32 g/L) was independently correlated to death in AKI patients with an OR of 10.99 (CI 95% 4.1-29.3, p<0.001). In addition, 78.2% of the dead patients were on mechanical ventilation. Besides age as a predictor of AKI development, diabetes and hypertension were the major risk factors of AKI development (OR 2.04, p<0.01, and 0.05 for diabetes and hypertension, respectively). Also, two or more comorbidities substantially increased the risk of AKI development in COVID-19 patients. Furthermore, high levels upon hospital admission of D-Dimer, Troponin I, and ProBNP and low serum albumin were associated with AKI development. Lastly, patients taking ACEI/ARBs had less chance to develop AKI stage II/III with OR of 0.19-0.27 (p<0.05-0.01). The incidence of AKI in hospitalized COVID-19 patients and the mortality rate among AKI patients were high and correlated with AKI staging. Furthermore, laboratory testing for serum albumin, hypercoagulability and cardiac injury markers maybe indicative for AKI development. Therefore, clinicians should be mandated to perform such tests on admission and follow-up in hospitalized patients.

Protein-losing enteropathy caused by Yersinia enterocolitica colitis

ABSTRACT A 7-month-old boy was admitted with acute gastro-enteritis accompanied by fever and hyponatraemic dehydration. The clinical course was complicated by severe hypokalaemia and hypo-albuminaemia with anasarca. Protein-losing enteropathy (PLE) owing to Yersinia enterocolitica colitis was diagnosed and was complicated by fungal sepsis owing to Kodomaea ohmeri. Colonoscopy demonstrated multiple diffuse ulcers and sub-epithelial haemorrhages extending from the rectum to the hepatic angle. He required prolonged nutritional support comprising partial parenteral feeding for 10 days, followed by a hypo-allergenic diet until 13 months of age when cow milk was tolerated. He was discharged on a normal diet and in good health at 19 months of age. Abbreviations AVPU scale: A alert, V verbally responsive, P painfully responsive, U unresponsive; CMV: cytomegalovirus; EBV: Epstein–Barr virus; HIV: human immunodeficiency virus; Ig: immunoglobulin; IBD: inflammatory bowel disease; IPEX: immune dysregulation, polyendocrinopathy, enteropathy, X-linked syndrome; PICU: paediatric intensive care unit; PLE: protein-losing enteropathy

Gastrointestinal AA amyloidosis secondary to chronic pyelonephritis presenting with refractory diarrhea and severe hypoalbuminemia

Secondary amyloidosis is a rare complication of chronic inflammatory diseases, such as collagen diseases, and is often difficult to treat. In addition, the gastrointestinal tract is frequently involved in amyloid deposition that often results in various disorders and symptoms. A 70-year-old woman was admitted to our hospital with refractory diarrhea and hypoalbuminemia. Abdominal computed tomography demonstrated extensive edematous wall thickening of the small intestine and colon. Video capsule endoscopy revealed multiple ulcerations with a white mossy appearance of the ileum. Double-balloon endoscopy showed severe circumferential ulcers in the entire ileum. Histological examination of ileum biopsy samples revealed severe amyloid deposition in the lamina propria and perivascular areas of the submucosa. The patient was diagnosed with gastrointestinal AA amyloidosis. The cause of AA amyloid deposition was presumed to be chronic pyelonephritis due to ureteral stones that had been left untreated for 35years. After treatment with ureteral drainage and antibiotics, the patient's symptoms and serological abnormalities improved dramatically. Here, we describe a case of severe gastrointestinal AA amyloidosis secondary to chronic pyelonephritis. Clinicians should thoroughly investigate the entire gastrointestinal tract in patients with refractory diarrhea and severe hypoalbuminemia considering the possibility of gastrointestinal amyloidosis.

Adjusted calcium concentration as a predictor of ionized hypocalcemia in hypoalbuminemic dogs.

BackgroundIonized calcium (iCa) is the biologically active fraction of total calcium (tCa) with clinical relevance to evaluate calcium homeostasis, but not all primary veterinarians have access to serum iCa. Formulas that adjust tCa to correct for variability in serum protein concentrations were not designed to predict iCa and are considered unreliable surrogates for iCa.ObjectivesTo determine whether adjusted calcium concentration (aCa) can predict ionized hypocalcemia in hypoalbuminemic dogs without hyperphosphatemia.AnimalsA total of 262 hypoalbuminemic dogs without hyperphosphatemia.MethodsRetrospective review of paired tCa and iCa. Patients were included if serum albumin concentration was ≤2.5 g/L and serum phosphorus concentration was ≤5 mg/dL. The aCa was calculated using tCa (mg/dL) − serum albumin concentration (g/dL) + 3.5 (g/dL). Sensitivity, specificity, positive (PPVs) and negative (NPVs) predictive values, and accuracy were determined for tCa and aCa at predicting any (<1.13 mmol/L) and moderate (<1.02 mmol/L) ionized hypocalcemia. Patients also were stratified into mild‐to‐moderate (2.0‐2.5 g/dL) and severe hypoalbuminemia (<2.0 g/dL).ResultsA total of 4296 dogs had paired results of which 262 met the inclusion criteria. Of these, 35 (13.4%) dogs had iCa < 1.13 mmol/L and 13 dogs (5.0%) had concentrations <1.02 mmol/L. The sensitivity, specificity, NPVs and PPVs of a decreased tCa and aCa for detecting moderate ionized hypocalcemia were 100% and 92.3%, 57.8% and 94.8%, 100% and 99.6%, and 11.0% and 48.2%, respectively, and accuracy was 60.0% and 94.7%, respectively.ConclusionsA low aCa was useful to detect ionized hypocalcemia in hypoalbuminemic nonhyperphosphatemic dogs. A normal aCa indicated that moderate ionized hypocalcemia was unlikely.

Prophylactic anticoagulants to prevent venous thromboembolism in patients with nephrotic syndrome-A retrospective observational study.

Nephrotic syndrome (NS) is associated with increased risk of venous thromboembolism (VTE). Guidelines suggest prophylactic anticoagulants to patients with high risk of thrombosis and low risk of bleeding, but the evidence behind this is poor. This study aims to investigate the effectiveness and risks of prophylactic anticoagulants (PAC) and investigate risk factors for VTE and bleeding in NS. A retrospective medical records study including adults with NS, biopsy proven glomerular disease in the county of Västernorrland, Sweden. Outcomes were VTE, bleeding and death. Patients divided into PAC- and no PAC group were compared using Fisher's exact test. Patient time was divided into serum/plasma(S/P)-albumin intervals (<20g/L and ≥20g/L) and VTE- and bleeding rates were calculated. In 95 included NS patients (PAC = 40, no PAC = 55), 7 VTE (7.4%) and 17 bleedings (18%) were found. Outcomes didn't differ significantly between the PAC and no PAC group. Time with S/P-albumin <20g/L conferred higher rates/100 years of VTE (IRR 21.7 (95%CI 4.5-116.5)) and bleeding (IRR 5.0 (1.4-14.7)), compared to time with S/P-albumin>20g/L. Duration of severe hypoalbuminemia (S/P-albumin <20g/L) in NS is a risk factor for both VTE and bleeding. There is a need for randomized controlled studies regarding the benefit of PAC in NS as well as risk factors of thrombosis and bleeding in NS.

Expert consensus on the use of human serum albumin in critically ill patients.

Expert consensus on the use of human serum albumin in critically ill patients.

Impact of Fluid Resuscitation Regimes in Relative Risk of Mortality in Burned Patients

Background; Some studies have supported the opinion that patients who get greater volumes of resuscitation fluids are at a higher chance of edema, complications, and probably bad outcomes. In the results of the International Society of Burn Injuries approximately half (49.5%) added colloid before 24h.&#x0D; This study aims to analyze the relative risk for mortality comparing resuscitation in the first 24 hours with Parkland and resuscitation with the use of Colloids. &#x0D; Material and Methods; This was an observational prospective cohort study conducted in the Service of Burns of the University Hospital Centre "Mother Teresa" in Tirana (UHCT), Albania. The study includes adult patients with critical burns &gt; 40% TBSA, hospitalized in the Intensive Care Unit of the service during the period 2014 to 2019. Resuscitation in the first 24 hours is done with Ringer Lactate according to Parkland and with Ringer Lactate with the addition of colloids after 12 hours.&#x0D; Results; The data for organ dysfunction and organ insufficiency were the same in the two groups without statistical significance. Mortality in the RL group was 48% (24 deaths of 50 patients) while in the RL + Colloid rehydrated group was 46% (23 deaths of 50 patients). Patients which have 40-60% burns and are rehydrated with RL + Colloids have a risk of death 0.4 times less than those rehydrated with RL.&#x0D; Conclusions; Resuscitation with Ringer lactate and Colloids in the first 24 hours of thermal damage is a rehydration alternative for the treatment of burn shock. This therapy especially helps patients with major burns &gt; 40% TBSA who during rehydration require large amounts of fluids and are associated with severe plasma hypoalbuminemia. Number Need to Treat (NNT benefit) is 10 so 1 in 10 patients can benefit in lowering the risk of death with RL + Colloid rehydration.

A RETROSPECTIVE ANALYSIS OF THE CLINICAL SEVERITY AND LABORATORY INVESTIGATIONS OF COVID INFECTED HEALTH CARE WORKERS AND THEIR FAMILY MEMBERS.

BACKGROUND AND METHODOLOGY- The healthcare professionals are at a higher risk of covid 19 infection. The multitude of investigations burdens the laboratory services and often the results do not correlate with disease progression .We planned to identify the laboratory parameters for early recognition , intervention and prognostication of covid 19. AIMS AND OBJECTIVES- The results were categorised according to clinical severity of the disease. The data was analysed using SPSS vs 25. Using logistic regression , we aimed to nd out which demographic variables and blood tests can accurately diagnose the severity of infection and also predict the disease outcome. RESULTS- Severe hypoalbuminemia is associated with severe covid infection. Age &gt; 60, Neutrophil- lymphocyte ratio above 3 and C- reactive protein more than 6mg/l were strong predictors of adverse outcome. CONCLUSION- These blood tests will decrease the tendency of over investigating without compromising the disease related information.

Investigation of the association between gall bladder wall thickness and hypoalbuminaemia in dogs.

To assess the correlation between gallbladder wall thickness and serum/plasma albumin concentrations in dogs. Retrospective searches of digital medical record databases were conducted to identify dogs that had either severely low serum/plasma albumin concentration (<1.5 g/dL) or ultrasonographic evidence of gallbladder wall thickening (>2 mm). Analysis of covariance models were used to analyze gallbladder wall thickness with sample type (serum vs plasma), age, etiology, albumin, and albumin ' etiology as the covariates. A total of 216 dogs met inclusion criteria. One-hundred and forty-six dogs had a thickened gallbladder wall (Group 1). Median serum/plasma albumin concentration for dogs in this group was 2.2 g/dL (1 to 5 g/dL), and 84 dogs (57.5%) had hypoalbuminemia (<2.5 g/dL). The search for dogs with severe hypoalbuminemia (< 1.5 g/dL) identified 70 dogs (Group 2). In this group, median gallbladder wall thickness was 1.3 mm (0.2 to 6.1 mm) and 17 dogs (24.3%) had a thickened gallbladder wall. Serum/plasma albumin concentration and gallbladder wall thickness were not significantly correlated for Group 1 (r = 0.0044, p = 0.9580) or Group 2 (r = -0.1137, p = 0.3487). A moderate negative correlation (-0.64) was identified between gallbladder wall thickness and albumin concentration in dogs with immune-mediated diseases (p = 0.03). Gallbladder wall thickness and serum/plasma albumin concentration are independent variables in dogs.