Hypoalbuminemia on Admission as an Independent Risk Factor for Acute Functional Decline after Infection

Abstract

The risk of acute functional decline increases with age, and concepts including frailty and post-acute care syndrome have been proposed; however, the effects of the nutritional status currently remain unclear. Patients admitted to the emergency department of Hitachi General Hospital for infectious diseases between April 2018 and May 2019 were included. To identify risk factors for functional decline at discharge, defined as Barthel Index <60, we investigated basic characteristics, such as age, sex, disease severity, the pre-morbid care status, and cognitive impairment, as well as laboratory data on admission, including albumin as a nutritional assessment indicator. In total, 460 surviving patients out of 610 hospitalized for infection were analyzed. In a multivariable logistic regression analysis, factors independently associated with Barthel Index <60 at discharge were age (adjusted OR 1.03, 95%CI 1.01–1.06, p = 0.022), serum albumin (adjusted OR: 0.63, 95%CI: 0.41–0.99, p = 0.043), and the need for care prior to admission (adjusted OR: 5.92, 95%CI: 3.15–11.15, p < 0.001). Hypoalbuminemia on admission in addition to age and the need for care prior to admission were identified as risk factors for functional decline in patients hospitalized for infection. Functional decline did not correlate with the severity of illness.

Risk factors associated with functional decline in older hospital survivors with acute lower respiratory tract infections: a prospective cohort study

“…In our study, we further founded that frailty was linked with a higher burden of comorbidities, an elevated prevalence of emotional and sleep disorders, cognitive impairment, as well as reduced levels of essential biological markers including lymphocytes, hemoglobin, and albumin. These findings are in alignment with prior research that revealed a correlation between acute functional decline in pneumonia patients and decreased lymphocytes, hemoglobin, and albumin levels [ 9 ]. It is plausible that these factors act as intermediary variables between frailty and functional decline.…”

“…Functional decline during hospitalization has been shown to bring to a broad range of adverse outcomes, including falls, poor quality of life, rehospitalization and even death, so early detection was needed to prevent adverse outcome [ 21 – 23 ]. A few studies have described function decline in the respiratory infectious diseases [ 9 , 24 – 27 ]. A previous study also found that about 23% older patients hospitalized with influenza suffered from function decline at discharge [ 16 ], which indicated functional decline was common in older patients with LRTIs.…”

“…Consistent with our study, these research efforts emphasize the importance of functionality. However, those researches mainly prioritized pathogen prevention in maintaining function [ 26 , 27 ] and only a few studies considered the role of malnutrition or frailty in predicting functional decline [ 9 ], which were far from capturing the full spectrum of physiological and pathological conditions in elderly individuals.…”

Comment on: “Predictive factors and clinical impact of ICU-acquired weakness on functional disability in mechanically ventilated patients with COVID-19″

“…Ahead of the systematic literature on general prognostic significance of hypoalbuminemia in COVID-19, Nakano et al outline on-admission hypoalbuminemia as an independent predictor for functional decline in patients ailing from infectious diseases (adjusted-OR: 0.63; 95% CI: 0.41-0.99, p-value=0.043). 3 , 4 Hence, the overlooked significance of serum albumin levels in the Yamada et al study, is concerning. 1 …”

Predictive value of total psoas muscle index for postoperative physical functional decline in older patients undergoing emergency abdominal surgery

“…Abdominal CT plays a critical role in the diagnosis and preoperative management of patients with acute abdomen; the psoas muscle area can be quickly and easily measured using CT as opposed to using the scoring system. Additionally, serum albumin levels are indicators of sarcopenia in older adults [ 17 ]; FD is reportedly associated with low serum albumin levels [ 18 ].…”