-
Annals of HepatologyDecompensated liver cirrhosis has a dismal prognosis, with an overall survival of 2-4 years, which is worse than for many oncological diseases. Albumin is an important... (Review)
Review
Decompensated liver cirrhosis has a dismal prognosis, with an overall survival of 2-4 years, which is worse than for many oncological diseases. Albumin is an important tool in the management of patients with cirrhosis, since it decreases for less than half the risk for post-paracentesis cardiocirculatory dysfunction and mortality associated with spontaneous bacterial infection, as well as, it triplicates the response to terlipressin in patients with hepatorenal syndrome. Recently, research on albumin has been a hot topic, with important new insights such as the characterization of the pleiotropic effects of albumin (which surpass its oncotic properties) and the concept of effective albumin concentration. In fact, patients with liver cirrhosis present posttranslational modifications on albumin that compromises its function. Those modified albumin forms were proved to have prognostic value and its knowledge may change the paradigm of albumin treatment. In this review, we critically summarize the latest evidence on the potential benefits of albumin in patients with end-stage liver disease.
Topics: Animals; Biomarkers; End Stage Liver Disease; Humans; Hypoalbuminemia; Liver; Liver Cirrhosis; Protein Processing, Post-Translational; Serum Albumin, Human; Treatment Outcome
PubMed: 29893696
DOI: 10.5604/01.3001.0012.0916 -
Scientific Reports May 2021Hypoalbuminemia is associated with vascular endothelial dysfunction and the development of chronic cardiovascular diseases. However, the relationship between serum...
Hypoalbuminemia is associated with vascular endothelial dysfunction and the development of chronic cardiovascular diseases. However, the relationship between serum albumin concentration and blood pressure changes remains controversial. Community-based longitudinal cohort data collected from Korean Genome and Epidemiology Study were used in this study. Hypoalbuminemia was defined as a serum albumin concentration of ≤ 4.0 g/dL. A total of 4325 participants were categorized into control (n = 3157) and hypoalbuminemia (n = 1168) groups. Serum albumin had a non-linear relationship with the risk of hypertension development. A genome-wide association study revealed 71 susceptibility loci associated with hypoalbuminemia. Among susceptibility loci, genetic variations at rs2894536 in LOC107986598 and rs10972486 in ATP8B5P were related to elevated blood pressure. Serum albumin (HR = 0.654, 95% CI 0.521-0.820) and polymorphisms of rs2894536 (HR = 1.176, 95% CI 1.015-1.361) and rs10972486 (HR = 1.152, 95% CI 1.009-1.316) were significant predictors of hypertension development. Increased albumin concentration instrumented by 2 hypoalbuminemia-associated SNPs (rs2894536 and rs10972486) was associated with decreased HRs for hypertension development (HR = 0.762, 95% CI 0.659-0.882 and HR = 0.759, 95% CI 0.656-0.878). Our study demonstrated that genetically determined hypoalbuminemia is a significant predictor of incipient hypertension.
Topics: Adult; Cohort Studies; Female; Genetic Predisposition to Disease; Genome-Wide Association Study; Humans; Hypertension; Hypoalbuminemia; Longitudinal Studies; Male; Middle Aged; Prognosis; Republic of Korea; Retrospective Studies; Risk Factors; Serum Albumin
PubMed: 34050200
DOI: 10.1038/s41598-021-89775-3 -
World Journal of Gastroenterology Aug 2022Biliary decompression is well known to greatly decrease the risks of mortality in acute cholangitis (AC). Although early biliary drainage is recommended by the treatment... (Review)
Review
BACKGROUND
Biliary decompression is well known to greatly decrease the risks of mortality in acute cholangitis (AC). Although early biliary drainage is recommended by the treatment guidelines for AC, the best time for performing this procedure is yet to be established. Furthermore, since the clinical outcomes of patients with severe AC vary dramatically, screening for patients that could benefit the most from early drainage would be more beneficial than the drainage performed based on the severity grade criteria.
AIM
To investigate the optimal drainage timing for AC patients with each disease severity grade and organ dysfunction.
METHODS
In this retrospective monocenter cohort analysis, we reviewed 1305 patients who were diagnosed with AC according to the Tokyo guidelines 2018 at a Chinese tertiary hospital between July 2016 and December 2020. Demographic characteristics including age and sex, clinical and laboratory characteristics, and imaging findings of each patient were obtained from electronic medical records. We investigated the all-cause in-hospital mortality (IHM), hospital length of stay (LOS), and hospitalization costs associated with the timing of biliary drainage according to the severity grading and different dysfunctioning organs and predictors [age, white blood cell (WBC) count, total bilirubin, albumin, lactate, malignant obstruction, and Charlton comorbidity index (CCI)].
RESULTS
Biliary drainage within 24 or 48 h in Grade III AC patients could dramatically decrease IHM (3.9% 9.0%, = 0.041; 4% 9.9%, = 0.018, respectively), while increasing LOS and hospitalization costs. Multivariate logistic analysis revealed that neurological, respiratory, renal, and cardiovascular dysfunctions, hypoalbuminemia, and malignant obstruction were significantly associated with IHM (odds ratio = 5.32, 2.541, 6.356, 4.021, 5.655, and 7.522; < 0.001, = 0.016, < 0.001, = 0.012, < 0.001, and < 0.001; respectively). Biliary decompression performed within 12 h of admission significantly decreased the IHM in AC patients with neurological dysfunction (0% 17.3%, = 0.041) or with serum lactate > 2 mmol/L (0% 5.4%, = 0.016). In the subgroup of AC patients with renal dysfunction, abnormal WBC count, hyperbilirubinemia, or hypoalbuminemia, early drainage (< 24 h) reduced the IHM (3.6% 33.3%, = 0.004; 1.9% 5.8%, = 0.031; 1.7% 5.0%, = 0.019; 0% 27%, = 0.026; respectively). The IHM was lower in patients with AC combined with hepatic dysfunction, malignant obstruction, or a CCI > 3 who had undergone biliary drainage within 48 h (2.6% 20.5%, = 0.016; 3.0% 13.5%, = 0.006; 3.4% 9.6%, = 0.021; respectively).
CONCLUSION
Biliary drainage within 12 h is beneficial for AC patients with neurological or cardiovascular dysfunction, while complete biliary decompression within 24 h of admission is recommended for treating patients with Grade III AC.
Topics: Acute Disease; Albumins; Bilirubin; Cholangiopancreatography, Endoscopic Retrograde; Cholangitis; Drainage; Humans; Hypoalbuminemia; Lactates; Retrospective Studies
PubMed: 36157549
DOI: 10.3748/wjg.v28.i29.3934 -
Nutricion Hospitalaria Oct 2014Albumin is considered an important extracellular antioxidant molecule. hypoalbuminemia is a strong and independent predictor of mortality in patients on hemodialysis....
INTRODUCTION
Albumin is considered an important extracellular antioxidant molecule. hypoalbuminemia is a strong and independent predictor of mortality in patients on hemodialysis. The present study evaluated the relation between hypoalbuminemia and oxidative stress by comparing superoxide dismutase activity, lipid peroxidation and antioxidant micronutrient consumption in chronic renal failure patients.
METHODS
A case-control study was carried out with 64 patients of both sexes aged 18 to 59 years. The patients with hypoalbuminemia (ALB < 3,5 g/dL) were defined as case (n = 26) and control (n = 38) those with ALB ≥ 3.5 g/dL.Determinations of activity superoxide dismutase (SOD)and nitric oxide production by the contraction of nitrite in erythrocytes, concentration of malondialdehyde (MDA)in plasma, lipid profile and micronutrient antioxidants intake were performed. For comparisons between groups,the Student t test was used. Possible associations between variables were tested using the chi-square test and Pearson correlation test.
RESULTS
Consumption of copper was significantly lower(p < 0.05) in the group with hypoalbuminemia. There was a positive correlation between the concentrations of albumin and intake copper (r = 0.280). Negative correlation was found between albumin and MDA concentrations.
CONCLUSION
Hypoalbuminemia is associated with increased lipid peroxidation, and can contribute to oxidative stress in chronic renal failure patients. Additionally, patients with chronic renal disease undergoing hemodialysis evaluated in this study had reduced consumption of cooper.
Topics: Adolescent; Adult; Case-Control Studies; Female; Humans; Hypoalbuminemia; Kidney Failure, Chronic; Male; Middle Aged; Oxidative Stress; Renal Dialysis; Young Adult
PubMed: 25335687
DOI: 10.3305/nh.2014.30.4.7667 -
Relationship between Oral Assessment Guide score and hypoalbuminemia in newly hospitalized patients.Journal of Oral Science 2020This cross-sectional study investigated the relationship between Oral Assessment Guide (OAG) scores and malnutrition in newly hospitalized patients. A total of 880...
This cross-sectional study investigated the relationship between Oral Assessment Guide (OAG) scores and malnutrition in newly hospitalized patients. A total of 880 hospitalized adults were enrolled. Hypoalbuminemia was defined as serum albumin less than 3.5 g/dL. Patients with hypoalbuminemia were older (P < 0.001), had a higher prevalence of respiratory diseases (P < 0.01), a higher prevalence of digestive diseases (P < 0.01), a lower prevalence of oral feeding (P < 0.001), a lower body mass index (P < 0.001), and higher OAG scores (P < 0.001) than those without hypoalbuminemia. Multivariate logistic regression analyses showed that the prevalence of hypoalbuminemia was significantly related to age (odds ratio [OR] = 1.05, P < 0.001), absence of oral feeding (OR = 2.72, P < 0.001), presence of respiratory diseases (OR = 2.53, P < 0.01), presence of digestive diseases (OR = 1.64, P < 0.01), and OAG scores (OR = 1.14, P < 0.01). Regarding OAG scores, the OR of hypoalbuminemia was greater in patients with disorders (scores 2 or 3) of swallowing (vs. score 1, OR = 1.83, P < 0.05) and saliva (vs. score 1, OR = 1.51, P < 0.05). There appears to be a positive association between OAG scores and hypoalbuminemia in hospitalized patients.
Topics: Adult; Cross-Sectional Studies; Humans; Hypoalbuminemia; Prevalence; Retrospective Studies; Risk Factors; Serum Albumin
PubMed: 31996528
DOI: 10.2334/josnusd.19-0019 -
The Journal of Trauma and Acute Care... Oct 2017The purpose of this study was to characterize associations among serum proteins, negative-pressure wound therapy (NPWT) fluid loss, and primary fascial closure (PFC)...
BACKGROUND
The purpose of this study was to characterize associations among serum proteins, negative-pressure wound therapy (NPWT) fluid loss, and primary fascial closure (PFC) following emergent laparotomy and temporary abdominal closure (TAC). We hypothesized that high levels of C-reactive protein (CRP) and NPWT output would be associated with hypoalbuminemia and failure to achieve PFC.
METHODS
We performed a retrospective analysis of 233 patients managed with NPWT TAC. Serum proteins and resuscitation indices were assessed on admission, initial laparotomy, and then at 48 hours, 96 hours, 7 days, and discharge. Correlations were assessed by Pearson coefficient. Multivariable regression was performed to identify predictors of PFC with cutoff values for continuous variables determined by Youden index.
RESULTS
Patients who failed to achieve PFC (n = 55) had significantly higher CRP at admission (249 vs. 148 mg/L, p = 0.003), initial laparotomy (237 vs. 154, p = 0.002), and discharge (124 vs. 72, p = 0.003), as well as significantly lower serum albumin at 7 days (2.3 vs. 2.5 g/dL, p = 0.028) and discharge (2.5 vs. 2.8, p = 0.004). Prealbumin (in milligrams per deciliter) was similar between groups at each time point. There was an inverse correlation between nadir serum albumin and total milliliters of NPWT output (r = -0.33, p < 0.001). Exogenous albumin administration (in grams per day) correlated with higher serum albumin levels at each time point: 48 hours: r = 0.26 (p = 0.002), 96 hours: r = 0.29 (p = 0.002), 7 days: r = 0.40 (p < 0.001). Albumin of less than 2.6 g/dL was an independent predictor of failure to achieve PFC (odds ratio, 2.59; 95% confidence interval, 1.02-6.61) in a multivariate model including abdominal sepsis, body mass index of greater than 40 kg/m, and CRP of greater than 250 mg/L.
CONCLUSIONS
Early and persistent systemic inflammation and high NPWT output were associated with hypoalbuminemia, which was an independent predictor of failure to achieve PFC. The utility of exogenous albumin following TAC requires further study.
LEVEL OF EVIDENCE
Prognostic study, level III; Therapeutic study, level IV.
Topics: Abdominal Wound Closure Techniques; Adult; Aged; Emergencies; Female; Humans; Hypoalbuminemia; Male; Middle Aged; Retrospective Studies; Risk Factors; Treatment Outcome
PubMed: 28837537
DOI: 10.1097/TA.0000000000001553 -
Chinese Journal of Cancer May 2017Hypoalbuminemia adversely affects the clinical outcomes of various cancers. The purpose of this study was to estimate the prognostic value of hypoalbuminemia 3-5 weeks... (Clinical Trial)
Clinical Trial
BACKGROUND
Hypoalbuminemia adversely affects the clinical outcomes of various cancers. The purpose of this study was to estimate the prognostic value of hypoalbuminemia 3-5 weeks after treatment in patients with metastatic renal cell carcinoma (mRCC) who received sorafenib or sunitinib as first-line treatment.
METHODS
In this single-center, retrospective study, we assessed the progression-free survival (PFS) and overall survival (OS) of 184 mRCC patients who received first-line sorafenib or sunitinib treatment. PFS and OS were compared between patients with post-treatment hypoalbuminemia (post-treatment albumin level <36.4 g/L) and those with normal post-treatment albumin level (albumin level ≥36.4 g/L). The Memorial Sloan Kettering Cancer Center (MSKCC) risk model stratified mRCC patients into three risk categories. Prognostic values of all patient characteristics including MSKCC risk category were determined by using univariate and multivariate Cox regression models. Prognostic value was further determined using the Harrell concordance index and receiver operating characteristic curve analysis.
RESULTS
The median PFS and OS of the 184 patients were 11 months (95% confidence interval [CI] 9-12 months) and 23 months (95% CI 19-33 months), respectively. Patients with post-treatment hypoalbuminemia had significantly shorter median PFS (6 months [95% CI 5-7 months]) and OS (11 months [95% CI 9-15 months]) than patients who had normal post-treatment albumin levels (PFS: 12 months [95% CI 11-16 months], P < 0.001; OS: 31 months [95% CI 24-42 months], P < 0.001), respectively. Multivariate analysis showed that post-treatment hypoalbuminemia was an independent predictor of PFS (hazard ratio [HR], 2.113; 95% CI 1.390-3.212; P < 0.001) and OS (HR, 2.388; 95% CI 1.591-3.585; P < 0.001). Post-treatment hypoalbuminemia could also be combined with the MSKCC risk category for better prediction about OS. The model that included post-treatment hypoalbuminemia and MSKCC risk category improved the predictive accuracy for PFS and OS (c-index: 0.68 and 0.73, respectively) compared with the basic MSKCC risk model (c-index: 0.67 and 0.70, respectively). The prognostic values for PFS and OS of the integrated MSKCC risk model involving post-treatment hypoalbuminemia were significantly more accurate than the basic MSKCC risk model using likelihood ratio analysis (both P < 0.001).
CONCLUSIONS
Post-treatment hypoalbuminemia can be considered an independent prognostic factor for patients with mRCC who undergo first-line treatment with tyrosine kinase inhibitors. Additionally, integrating post-treatment serum albumin level into the basic MSKCC risk model can improve the accuracy of this model in predicting patient overall survival and progression-free survival.
Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Renal Cell; Disease-Free Survival; Female; Humans; Hypoalbuminemia; Indoles; Male; Middle Aged; Neoplasm Metastasis; Niacinamide; Phenylurea Compounds; Prognosis; Proportional Hazards Models; Protein Kinase Inhibitors; Pyrroles; Sorafenib; Sunitinib; Treatment Outcome
PubMed: 28521783
DOI: 10.1186/s40880-017-0214-7 -
Clinical Nutrition ESPEN Oct 2021Coronavirus disease 2019 (COVID-19) elicits robust inflammatory reaction that may result in a declining albumin serum level. This meta-analysis aimed to evaluate the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Coronavirus disease 2019 (COVID-19) elicits robust inflammatory reaction that may result in a declining albumin serum level. This meta-analysis aimed to evaluate the prognostic properties of hypoalbuminemia for poor prognosis and factors that may influence the relationship.
METHOD
A systematic literature search of PubMed was conducted from inception to April 22, 2021. The main exposure was albumin level below normal range-defined by the included studies. The outcome of interest was composite poor outcome that comprises of mortality, severity, and the requirement of mechanical ventilation or intensive care unit.
RESULTS
There were 6200 patients from 19 studies. Meta-analysis showed that hypoalbuminemia was associated with composite poor outcome (OR 6.97 (95% CI 4.20-11.55), p < 0.001; I = 91.3%, p < 0.001). Meta-regression analysis showed that age (p = 0.44), gender (p = 0.76), HT (p = 0.97), DM (p = 0.40), CKD (p = 0.65), liver disease (p = 0.72), and malignancy (p = 0.84) did not affect the association. Subgroup analysis showed that hypoalbuminemia increased mortality (OR 6.26 (95% CI 3.26-12.04), p < 0.001; I = 69.6%, p < 0.01) and severity of the disease (OR 7.32 (95%CI 3.94-13.59), p < 0.001; I = 92.5%, p < 0.01). Pooled diagnostic analysis of hypoalbuminemia yielded a sensitivity of 0.63 (95% CI 0.52-0.72), specificity of 0.81 (95% CI 0.73-0.87), and AUC of 0.77. The probability of poor outcome was 70% in patients with hypoalbuminemia and 24% in patients with normal albumin level.
CONCLUSION
Hypoalbuminemia was associated with poor prognosis in COVID-19 patients.
Topics: COVID-19; Humans; Hypoalbuminemia; Intensive Care Units; Prognosis; SARS-CoV-2
PubMed: 34620307
DOI: 10.1016/j.clnesp.2021.07.003 -
Medicine Sep 2022Hypoalbuminemia is associated with fluid overload, the development of acute respiratory distress syndrome, and mortality. The co-administration of albumin and diuretics... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Hypoalbuminemia is associated with fluid overload, the development of acute respiratory distress syndrome, and mortality. The co-administration of albumin and diuretics for the treatment of patients with hypoalbuminemia is expected to increase urine output, without hemodynamic instability, and improve pulmonary function; however, these effects have not been systematically investigated. Here, we aimed to clarify the benefits of the co-administration of albumin and diuretics in mechanically ventilated patients.
METHODS
We searched for randomized, placebo-controlled trials that investigated the effects of the co-administration of albumin and diuretics compared with placebo and diuretics, in mechanically ventilated patients with hypoalbuminemia. We searched these trials in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via PubMed, and EMBASE databases. Primary outcomes were hypotensive events after the intervention, all-cause mortality, and the length of mechanical ventilation. Secondary outcomes were improvement in the ratio of partial pressure arterial oxygen and fraction of inspired oxygen (P/F ratio) at 24 hours, total urine output (mL/d), and the clinical requirement of renal replacement therapy (RRT).
RESULTS
From the 1574 records identified, we selected 3 studies for quantitative analysis. The results of albumin administration were as follows: hypotensive events (risk ratio [RR] -1.05 [95% confidence interval {CI}: 0.15-0.81]), all-cause mortality (RR 1.0 [95% CI: 0.45-2.23]), the length of mechanical ventilation in days (mean difference -1.05 [95% CI: -3.35 to 1.26]), and improvement in P/F ratio (RR 2.83 [95% CI: 1.42-5.67]). None of the randomized controlled trials reported the total urine output, and one reported that no participants required RRT. Adverse events were not reported during the trials. The certainty of evidence was low (in the hypotensive events after the intervention and all-cause mortality) to moderate (in the length of mechanical ventilation in days, improvement of P/F ratio, clinical requirement of RRT, and adverse events).
CONCLUSIONS
Although this treatment combination reduced the number of days for which mechanical ventilation was required, it did not reduce the all-cause mortality at 30 days. In conclusion, the co-administration of albumin and diuretics may reduce hypotensive events and improve the P/F ratio at 24 hours.
Topics: Albumins; Diuretics; Humans; Hypoalbuminemia; Metabolic Diseases; Oxygen; Respiration, Artificial
PubMed: 36123902
DOI: 10.1097/MD.0000000000030276 -
Acta Medica Indonesiana Apr 2023Chronic kidney disease (CKD) patients, particularly those who require renal replacement therapy, have a higher risk of hospitalization and mortality compared than the...
The Effect of Anemia and Hypoalbuminemia on Six-Months Hospitalization Risk in End Stage Chronic Kidney Disease Patients Undergoing Hemodialysis: A Retrospective Cohort Study.
BACKGROUND
Chronic kidney disease (CKD) patients, particularly those who require renal replacement therapy, have a higher risk of hospitalization and mortality compared than the general population. The patients can suffer hypoalbuminemia and anemia due to chronic inflammations, that might affect the risk of hospitalization risk. The aim of this study is to investigate the effect of albumin dan hemoglobin levels on the hospitalization incidence of patients with stage 5 chronic kidney disease who undergo chronic hemodialysis.
METHODS
This retrospective cohort study enrolled patients aged 18 years and older with end stage kidney disease who underwent regular hemodialysis at the Prof. dr. R. D Kandou Hospital, Manado, Indonesia. Patients with malignancy were excluded. We measured the hemoglobin and albumin baseline level and observed the hospitalization incidence over the next 6 months. We used the Chi Square test with significance level of p-value 0.05, to analyze the association between both anemia and hypoalbuminemia with risk of hospitalization over 6 months of follow up period.
RESULTS
We enrolled 202 patients as our participants, most of whom were men (61.8%), with a mean age of 60.21±9.32 years. There were 120 participants (59.4%) being hospitalized during 6-months-follow-up period. The mean level of albumin was 3.29±0.63 g/dl, while the mean hemoglobin level was 9.43±1.75 g/dl. This study found that most of the participants had hypoalbuminemia (62.9%) while 45% had anemia. We found significant associations between hypoalbuminemia and anemia with the risk of hospitalization within 6 months, with p values 0.001 and 0.007, respectively. The relative risk for being hospitalized over 6 months follow up period in patients having anemia was 2.32 (95% CI 1.29-4.17), and for hypoalbuminemia was 2.77 (95% CI 1.54-4.99).
CONCLUSION
Hypoalbuminemia and anemia are associated with increased risk of all causes hospitalization within 6 months in stage 5 chronic kidney disease patients undergoing hemodialysis.
Topics: Male; Humans; Middle Aged; Aged; Female; Retrospective Studies; Hypoalbuminemia; Kidney Failure, Chronic; Renal Dialysis; Anemia; Hospitalization; Hemoglobins; Renal Insufficiency, Chronic; Albumins; Metabolic Diseases
PubMed: 37524595
DOI: No ID Found