Clinical Research StudyLow Albumin Levels Are Associated with Mortality Risk in Hospitalized Patients
Introduction
Albumin, a major component of plasma protein, is required to maintain oncotic pressure, microvascular permeability, acid–base function, and to prevent platelet aggregation.1 Serum albumin is an important parameter in the assessment of the nutritional status of both acute and chronically ill patients.2
The frequency of hypoalbuminemia, defined as serum albumin levels <3.5 g/dL, was 21% at the time of admission in adult hospitalized patients.3 De novo hypoalbuminemia and worsening of existing hypoalbuminemia are also common.4 Low albumin levels have been associated with morbidity and mortality in various populations, including patients with acute myocardial infarction,5 heart failure,6 stroke,7, 8, 9 renal disease,10, 11 hip fracture,12 and malignancies.13, 14, 15, 16 Vincent et al.17 identified low albumin as a dose-dependent and independent predictor of a poor outcome in patients with acute illness. However, there are conflicting reports throughout the literature regarding the importance of albumin levels.18, 19, 20 Causality is the main controversy, and the main questions are whether low albumin levels directly contribute to increased morbidity and mortality and the role of albumin therapy.17
Albumin is not an essential protein for immediate survival; hence, in malnourished or acute illness hepatic production of albumin decreases with a decrease of serum albumin levels.21 Herrmann et al.3 reported that low serum albumin levels obtained within 48 hours of admission were associated with increased length of stay and in-hospital mortality. However, because albumin levels may decrease early with severe illness, levels obtained 48 hours after admission may be lower than admission levels.3, 21
In the present study with a large cohort of patients hospitalized to medical wards, the association between albumin levels and important hospitalization outcomes, including length of admission, all-cause in-hospital mortality, and mortality at the end of follow-up (up to 6 years) was evaluated.
Section snippets
Methods
The study was conducted in a large, 1300-bed, university-affiliated, tertiary medical center. Most admissions to the 10 medical wards are through the emergency department. Historical prospective collected data were extracted from the medical records of all patients admitted for any cause to the hospital's medical wards between January 1, 2011 and December 31, 2013. Mortality data according to the population registry of the Ministry of the Interior were obtained up to February 1, 2017.
Study Cohort
There were 73,796 admissions to the 10 medical wards during the study period. After exclusion of repeat admissions (38,486 admissions) and patients with no measurement of albumin values within 24 hours of admission or before discharge (4578 patients), the final study cohort consisted of 30,732 patients. Mean age of the cohort was 67 ± 18 years; 15,688 (51%) were male.
Most patients had normal albumin levels on admission (20,124, 65%), 29% of patients had hypoalbuminemia, mostly mild (7334
Discussion
Our study focused on patients admitted to medical wards with serum albumin levels obtained within 24 hours of admission and before discharge. The results indicate increased mortality risk in patients with low albumin levels on admission and/or before discharge.
Although our finding of hypoalbuminemia as an independent mortality predictor is not novel, and numerous studies reported that hypoalbuminemia was associated with increased mortality in different patient groups and settings,5, 6, 7, 8, 9,
Acknowledgments
We thank Mrs. Tzipora Shochat for her statistical assistance.
References (30)
- et al.
Decreased admission serum albumin level is an independent predictor of long-term mortality in hospital survivors of acute myocardial infarction. Soroka Acute Myocardial Infarction II (SAMI-II) project
Int J Cardiol
(2016) - et al.
Usefulness of serum albumin concentration for in-hospital risk stratification in frail, elderly patients with acute heart failure. Insights from a prospective, monocenter study
Int J Cardiol
(2008) - et al.
Hypoalbuminemia predicts acute stroke mortality: Paul Coverdell Georgia stroke registry
J Stroke Cerebrovasc Dis
(2010) - et al.
C-reactive protein and albumin as predictors of all-cause and cardiovascular mortality in chronic kidney disease
Kidney Int
(2005) - et al.
Serum albumin, C-reactive protein, interleukin 6, and fetuin a as predictors of malnutrition, cardiovascular disease, and mortality in patients with ESRD
Am J Kidney Dis
(2006) - et al.
Undernutrition is predictive of early mortality after palliative self-expanding metal stent insertion in patients with inoperable or recurrent esophageal cancer
Gastrointest Endosc
(2006) - et al.
Nutritional status affects long term survival after lobectomy for lung cancer
Lung Cancer
(2007) - et al.
Prolonged length of stay and reduced functional improvement rate in malnourished stroke rehabilitation patients
Arch Phys Med Rehabil
(1996) - et al.
Hypoalbuminemia at admission is associated with increased incidence of in-hospital complications in geriatric trauma patients
Am J Surg
(2016) - et al.
Impact of body mass index and albumin on morbidity and mortality after cardiac surgery
J Thorac Cardiovasc Surg
(1999)
Association between serum albumin and mortality from cardiovascular disease, cancer, and other causes
Lancet
Relationship between admission albumin levels and rehabilitation outcomes in older patients
Arch Gerontol Geriatr
Prognostic value of rising serum albumin during hospitalization in patients with acute heart failure
Am J Cardiol
Role of admission serum albumin levels in patients with intracerebral hemorrhage
Acta Neurol Belg
Admission serum albumin is predicitve of outcome in critically ill trauma patients
Am Surg
Cited by (199)
High Serum Albumin Levels Were Associated With Acute Kidney Injury in Pediatric Surgical Intensive Care Units
2024, Journal of Pediatric SurgeryOptimized expression and purification of a human adenosine deaminase in E. coli and characterization of its Asp8Asn variant
2024, Protein Expression and PurificationIs Preoperative Serum Albumin Predictive of Adverse Outcomes in Head and Neck Cancer Surgery?
2023, Journal of Oral and Maxillofacial SurgeryCharacteristics and risk factors of facial pressure injuries in acute inpatients using noninvasive positive pressure ventilation: A retrospective case control study
2023, Intensive and Critical Care Nursing
Funding: None.
Conflicts of Interest: None.
Authorship: AA: Substantial contributions to conception and design, acquisition of data or analysis and interpretation of data, drafting the article or revising it critically for important intellectual content, final approval of the version to be published. HMI: Substantial contributions to conception and design, acquisition of data or analysis and interpretation of data, drafting the article or revising it critically for important intellectual content, final approval of the version to be published. AA: Substantial contributions to conception and design, acquisition of data or analysis and interpretation of data, drafting the article or revising it critically for important intellectual content, final approval of the version to be published. IS: Substantial contributions to conception and design, acquisition of data or analysis and interpretation of data, drafting the article or revising it critically for important intellectual content, final approval of the version to be published.