Hypoalbuminemia Is a Strong Predictor of 30-Day All-Cause Mortality in Acutely Admitted Medical Patients: A Prospective, Observational, Cohort Study

Abstract

ObjectiveEmergency patients with hypoalbuminemia are known to have increased mortality. No previous studies have, however, assessed the predictive value of low albumin on mortality in unselected acutely admitted medical patients. We aimed at assessing the predictive power of hypoalbuminemia on 30-day all-cause mortality in a cohort of acutely admitted medical patients.MethodsWe included all acutely admitted adult medical patients from the medical admission unit at a regional teaching hospital in Denmark. Data on mortality was extracted from the Danish Civil Register to ensure complete follow-up. Patients were divided into three groups according to their plasma albumin levels (0–34, 35–44 and ≥45 g/L) and mortality was identified for each group using Kaplan-Meier survival plot. Discriminatory power (ability to discriminate patients at increased risk of mortality) and calibration (precision of predictions) for hypoalbuminemia was determined.ResultsWe included 5,894 patients and albumin was available in 5,451 (92.5%). A total of 332 (5.6%) patients died within 30 days of admission. Median plasma albumin was 40 g/L (IQR 37–43). Crude 30-day mortality in patients with low albumin was 16.3% compared to 4.3% among patients with normal albumin (p<0.0001). Patients with low albumin were older and admitted for a longer period of time than patients with a normal albumin, while patients with high albumin had a lower 30-day mortality, were younger and were admitted for a shorter period. Multivariable logistic regression analyses confirmed the association of hypoalbuminemia with mortality (OR: 1.95 (95% CI: 1.31–2.90)). Discriminatory power was good (AUROC 0.73 (95% CI, 0.70–0.77)) and calibration acceptable.ConclusionWe found hypoalbuminemia to be associated with 30-day all-cause mortality in acutely admitted medical patients. Used as predictive tool for mortality, plasma albumin had acceptable discriminatory power and good calibration.

Short-term changes in liver tests predict long-term mortality

“…This was true of a single measurement as previously demonstrated3 13 14 and of an albumin trend. Importantly, the likelihood of mortality was predicted by the extent of a decrement in albumin over a number of days.…”

Malnutrition-associated liver steatosis and ATP depletion is caused by peroxisomal and mitochondrial dysfunction

“…The results of this study could potentially lead to novel treatment strategies for severely malnourished children. For example, numerous studies have shown that hypoalbuminemia is strongly associated with increased mortality in critically sick patients [59].…”

Evaluation of Hypoalbuminemia as a Predictor of Clinical Outcome in Critically Ill Children in Alexandria University Children's Hospital

“…3 Normally, albumin has a long half-life (15-19 days), but the plasma albumin can rapidly fall by 10-15 g/l in 3 to 5 days in critically ill patients. 4 www.jmscr.igmpublication. The inflammatory process can decrease the synthesis increase of albumin and increase its breakdown.…”