Hypoalbuminemia Reflects Nutritional Risk, Body Composition and Systemic Inflammation and Is Independently Associated with Survival in Patients with Colorectal Cancer

Abstract

It has long been recognized that albumin has prognostic value in patients with cancer. However, although the Global Leadership Initiative on Malnutrition GLIM criteria (based on five diagnostic criteria, three phenotypic criteria and two etiologic criteria) recognize inflammation as an important etiologic factor in malnutrition, there are limited data regarding the association between albumin, nutritional risk, body composition and systemic inflammation, and whether albumin is associated with mortality independent of these parameters. The aim of this study was to examine the relationship between albumin, nutritional risk, body composition, systemic inflammation, and outcomes in patients with colorectal cancer (CRC). A retrospective cohort study (n = 795) was carried out in which patients were divided into normal and hypoalbuminaemic groups (albumin <35 g/L) in the presence and absence of a systemic inflammatory response C-reactive protein (CRP >10 and <10 mg/L, respectively). Post-operative complications, severity of complications and mortality were considered as outcome measures. Categorical variables were analyzed using Chi-square test χ 2or linear-by-linear association. Survival data were analyzed using univariate and multivariate Cox regression. In the presence of a systemic inflammatory response, hypoalbuminemia was directly associated with Malnutrition Universal Screening Tool MUST (p < 0.001) and inversely associated with Body Mass Index BMI (p < 0.001), subcutaneous adiposity (p < 0.01), visceral obesity (p < 0.01), skeletal muscle index (p < 0.001) and skeletal muscle density (p < 0.001). There was no significant association between hypoalbuminemia and either the presence of complications or their severity. In the absence of a systemic inflammatory response (n = 589), hypoalbuminemia was directly associated with MUST (p < 0.05) and inversely associated with BMI (p < 0.01), subcutaneous adiposity (p < 0.05), visceral adiposity (p < 0.05), skeletal muscle index (p < 0.01) and skeletal muscle density (p < 0.001). Hypoalbuminemia was, independently of inflammatory markers, associated with poorer cancer-specific and overall survival (both p < 0.001). The results suggest that hypoalbuminemia in patients with CRC reflects both increased nutritional risk and greater systemic inflammatory response and was independently associated with poorer survival in patients with CRC.

The systemic inflammatory response and clinicopathological characteristics in patients admitted to hospital with COVID-19 infection: Comparison of 2 consecutive cohorts

“…Similarly, with reference to a low serum albumin concentration, a cytokine storm would increase the likelihood of mortality. In the case of a low albumin it is clear that this may reflect both an ongoing systemic inflammatory response and also poor nutritional status (19). It may be that the strong prognostic value of frailty also reflects poor nutritional status since a systemic inflammatory response occurring against a background of low metabolic reserves is likely to lead to cellular and organ dysfunction.…”

<p>The Significance of Platelet–Albumin–Bilirubin (PALBI) Grade in Hepatocellular Carcinoma Patients Stratified According to Platelet Count</p>

“…29 Hypoalbuminemia reflects nutritional risk and is associated with the rapid progress, poor survival, and high risk of recurrence in several types of malignancies, including HCC. [30][31][32] In addition, abnormal level of TBIL is an important reflection of liver injury. Among the prognostic indicators of liver function, serum ALB and TBIL have been demonstrated to be the two most prominent prognostic factors.…”

C-Reactive Protein/Albumin Ratio Is a Powerful Prognostic Indicator for Survival in Surgically Resected Gastrointestinal Stromal Tumors: A Retrospective Cohort Study

“…Therefore, several studies support the theory that the changes in systemic in ammatory factors have a particular prognostic value for cancer [8][9][10][11]. To predict the prognosis of patients with malignant tumors more accurately and facilitate clinical application, recent studies have veri ed some in ammatory indicators obtained by routine serum examination, such as CRP, albumin, GPS and CAR [28][29][30][31].…”