Prealbumin Serum Concentrations as a Useful Tool in the Assessment of Malnutrition in Hospitalized Patients

Abstract

Background: Protein-energy malnutrition (PEM) is a common condition among patients admitted to hospitals, and it is associated with a worse prognosis and increased mortality. Although several screening systems have been developed, PEM is still poorly recognized, and there is no consensus on which test is more reliable and feasible in clinical practice. Prealbumin (PAB) is a potential useful PEM marker because its serum concentrations are closely related to early changes in nutritional status. Methods: We studied PEM prevalence and PAB serum concentrations in 108 hospitalized patients. The Detailed Nutritional Assessment (DNA) was used as the reference method to determine PEM. PAB performance was compared with that of 2 other methods, the Subjective Global Assessment (SGA) and the Prognostic Inflammatory and Nutritional Index score (PINI). Results: According to the DNA reference method, 41% of patients were classified with mild malnutrition and 19% with severe malnutrition. PAB showed the best concordance with the standard DNA method (concordance index, 76.8%) and a good sensitivity/specificity profile (83.1%/76.7%) compared with SGA and PINI. Conclusions: We conclude that PAB could represent a feasible and reliable tool in the evaluation of malnutrition, especially in settings where it is difficult to obtain

Comparison of two malnutrition risk screening methods (MNA and NRS 2002) and their association with markers of protein malnutrition in geriatric hospitalized patients

“…In our study, prealbumin levels showed a more gradual decline with increasing NRS as compared with serum albumin levels. Similar to serum albumin and retinolbinding protein, prealbumin levels are influenced by systemic inflammatory diseases, limiting their use in acutely ill patients (Lopez-Hellin et al, 2002;Devoto et al, 2006). This might explain why prealbumin levels in our study declined with increasing NRS scores, which were more influenced by comorbidities compared with the MNA score.…”

“…However, its function in nutritional screening and in predicting mortality is controversial (Ferguson et al, 1993;Brugler et al, 2002;Langkamp-Henken et al, 2005;Devoto et al, 2006;Carriere et al, 2008). Robinson et al (2003) found prealbumin to be a significant predictor of malnutrition, whereas serum albumin and retinol-binding protein were not.…”

“…Many of them are influenced by factors other than nutrition, especially inflammation, and are, therefore, not specific for malnutrition (Devoto et al, 2006). The aim of our study was to compare two scores for malnutrition (MNA and NRS) in their ability to predict the degree of protein malnutrition, especially the serum concentrations of visceral proteins, that is albumin, prealbumin, and retinol-binding protein.…”

Assessment of preoperative and postoperative prealbumin in thoracic surgery – a two months experience in a Romanian university hospital / Evaluarea preoperatorie şi postoperatorie a prealbuminei în chirurgia toracică - experiența de 2 luni a unui spital universitar din România

“…In accordance with the reference method, 41% of subjects had mild malnutrition and 19% suffered from severe malnutrition. Prealbumin showed the best agreement with the standard method and a good profile of sensitivity and specificity, compared with SGA and Prognostic Inflammatory and Nutritional Index, and could be used as a practical and valid method of assessing malnutrition (46). In summary, several studies show the benefit of some nutritional risk score over others, but many suggest the combined use of these tools along with determining prealbumin levels, which is the reason why we also chose this approach in our study.…”

Avaliação e monitoramento do estado nutricional de pacientes hospitalizados: uma proposta apoiada na opinião da comunidade científica

“…A pré-albumina, por ter uma meia-vida mais curta do que a albumina, é apontada como marcador mais sensível para detectar desnutrição 24 , contudo o alto custo do exame dificulta o seu uso de rotina. Por outro lado, ambos indicadores podem estar alterados em algumas doenças crônicas podendo mascarar os verdadeiros resultados 25 .…”