Serum Albumin Level at Admission: Mortality and Clinical Outcome in Geriatric Patients

D'Erasmo, E; Pisani, Daniela; Ragno, Alessandro; Romagnoli, Stefano; Spagna, G; Acca, M

doi:10.1097/00000441-199707000-00004

Cited by 13 publications

(5 citation statements)

References 17 publications

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“…More specifically, diminished levels of serum albumin, besides implying higher in-hospital mortality levels,37 are also associated with death in the general elderly population 33. In agreement with our findings, other authors37 have described higher in-hospital mortality among geriatric patients with albumin levels lower than 3.3 mg/dL at admission. Additionally, other researchers have documented a correlation between mortality at one year following discharge and albumin levels lower than 3.5 mg/dL at admission 12…”

Section: Discussionsupporting

confidence: 92%

“…Poor nutritional condition has already been established as an independent predictor of bad prognosis at admission, and this association is not exclusively due to illness severity, comorbidities, or functional impairment 36. More specifically, diminished levels of serum albumin, besides implying higher in-hospital mortality levels,37 are also associated with death in the general elderly population 33. In agreement with our findings, other authors37 have described higher in-hospital mortality among geriatric patients with albumin levels lower than 3.3 mg/dL at admission.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of In-Hospital Mortality Among Older Patients

Silva

Szlejf

Farfel

et al. 2009

Clinics

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OBJECTIVE:The objective of this study was to determine predictors of in-hospital mortality among older patients admitted to a geriatric care unit.INTRODUCTION:The growing number of older individuals among hospitalized patients demands a thorough investigation of the factors that contribute to their mortality.METHODS:This was a prospective observational study implemented from February 2004 to October 2007 in a tertiary university hospital. A consecutive sample of 922 patients was evaluated for possible inclusion in this study. Patients hospitalized for palliative care, those who declined to participate, and those with incomplete data were excluded, resulting in a group of 856 patients aged 60 to 104 years. Bivariate and multivariate analyses were performed to determine associations between in-patient mortality and gender, age, length of stay, number of prescribed medications and diagnoses at admission, history of heart failure, neoplastic disease, immobility syndrome, delirium, infectious disease, and laboratory tests at admission (serum albumin and creatinine).RESULTS:The overall mortality rate was 16.4%. The following factors were associated with higher in-hospital mortality: delirium (OR=4.13, CI=2.65–6.44, P<.001), neoplastic disease (OR=3.38, CI=2.11–5.42, P<.001), serum albumin levels at admission <3.3mg/dL (OR=3.23, CI=2.03–5.13, P<.001), serum creatinine levels at admission ≥ 1.3mg/dL (OR=2.39, CI=1.53–3.72, P<.001), history of heart failure (OR=1.97, CI=1.20–3.22, P=.007), immobility (OR=1.84, CI=1.16–2.92, P =.009), and advanced age (OR=1.03, CI=1.01–1.06, P=.019).CONCLUSIONS:This study strengthens the perception of delirium as a mortality predictor among older inpatients. Cancer, immobility, low albumin levels, elevated creatinine levels, history of heart failure and advanced age were also related to higher mortality rates in this population.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Predictors of In-Hospital Mortality Among Older Patients

Silva

Szlejf

Farfel

et al. 2009

Clinics

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“…These measures include significant medical conditions, current pharmacological treatment, functional status (aside from significant MMSE variation), and physical examination findings. Minimal variation in laboratory data was observed in our study group, with the exception of albumin which is a recognized predictor of survival in elderly patients (McMurtry and Rosenthal 1995; D’Erasmo et al 1997) and CRP which is a risk factor for cardiovascular disease (Tracy et al 1997; Buckley et al 2009) (Table 1). Although blood pressure was not significantly higher in subjects who survived 360 days, hypertension was more common in the survivor group.…”

Section: Discussionmentioning

confidence: 60%

Functional measures, inflammatory markers and endothelin-1 as predictors of 360-day survival in centenarians

Szewieczek¹,

Francuz²,

Duława³

et al. 2015

AGE

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Centenarians represent a rapidly growing population. To better characterize this specific age group, we have performed a cross-sectional study to observe associations between functional measures and a range of biochemical markers, including inflammatory markers and their significance as predictors of 360-day survival. Medical history and physical and functional assessment (Mini-Mental State Examination (MMSE), Katz Index (activities of daily living, ADL) and Barthel Index (Barthel Index) of Activities of Daily Living, and Lawton Instrumental Activities of Daily Living Scale (Lawton IADL)) were conducted on 86 101.9 ± 1.2-year-old (mean ± SD) subjects (70 women, 16 men). Blood tests were performed on 84 subjects of whom 43 also had extended biomarker assessment. As a reference group 30 51.8 ± 5.0-year old healthy subjects (20 women, 10 men) were recruited. The centenarians received follow-up phone calls. Fifty-two centenarians (60 %) survived ≥360 days. Longer survival was associated with higher MMSE (hazard ratio, HR = 0.934, 95 % confidence interval (CI) 0.896–0.975, P = .002), ADL (HR = 0.840, 95 % CI 0.716–0.985, P = .032), Barthel Index (HR = 0.988, 95 % CI 0.977–0.999, P = .026), and albumin level (HR .926, 95 % CI 0.870–0.986, P .016) and with lower white blood cell (WBC) (HR = 1.161, 95 % CI 1.059–1.273, P = .001), C-reactive protein (CRP) (HR = 1.032, 95 % CI 1.014–1.050, P < .001), IL-6 (HR = 1.182, 95 % CI 1.047–1.335, P = .007), and endothelin-1 (ET-1) level (HR = 3.711, 95 % CI 1.233–11.169, P = .020). Centenarians had higher 360-day survival probability with MMSE ≥13 (P < .001), ADL ≥1 (P < .001), Barthel Index ≥15 (P < .001), Lawton IADL ≥10 points (P = .009), WBC <8.3 G/L (P = .039), CRP <10 mg/L (P < .001), IL-6 <6 pg/mL (P .002), and ET-1 <1.1 pg/mL (P .007). Our results indicate that functional measures, inflammatory markers, and endothelin-1 are predictors of 360-day survival in centenarians.

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“…S erum albumin level has been shown to be a good index of survival in a wide variety of patient populations, including general hospital admissions (1), surgical patients (2,3), patients in the medical intensive care unit (4-6), and geriatric patients (7), as well as chronic renal failure patients on chronic hemodialysis (HD) (8). The correlation of low serum albumin with poor survival is thought to be based on two factors: first, albumin is a visceral protein and therefore serves as a marker of nutritional status; and second, albumin is an acute-phase reactant, its production rate falling in the presence of inflammation (9).…”

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confidence: 99%

Total Lymphocyte Count: A Promising Prognostic Index of Mortality in Patients on CAPD

et al. 2000

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Objective In view of the limitations of albumin in peritoneal dialysis (PD), we set out to evaluate whether total lymphocyte counts (TLC) could serve as a better prognostic indicator. We were also interested in how these parameters might differ between PD and hemodialysis (HD) patients. Design In a retrospective study, we reviewed 113 charts from our dialysis unit. All laboratory analyses were performed by the Department of Clinical Pathology of the Nassau County Medical Center, using standard procedures. Intact parathyroid hormone (PTH) was sent out to Nichols Laboratories. Setting All patients originated from the renal clinic at Nassau County Medical Center, a 612 bed public hospital. Patients The 38 PD and 75 HD patients selected had been receiving dialysis for at least 12 months and up to 3 years. The PD patients received either continuous ambulatory and/or cycler PD. For the survivors, the averages of their routine chemical analyses were considered their representative values. For the nonsurvivors, the most recent laboratory values prior to their end point were considered. Main Outcome Measures Mortality or apparent malnutrition leading to transfer to HD represented the end points for PD patients. Mortality alone was used as the end point for HD patients. Results Within the PD population, serum albumin was not significantly lower in nonsurvivors compared to survivors, while the TLC was significantly lower in nonsurvivors (1277 ± 146/mm3 vs 2249 ± 236/mm3, p = 0.0036). The HD population demonstrated a significant difference in both TLC and serum albumin levels between its two prognostic groups; albumin was the better discriminator. Nonsurvivors had a 20% lower serum albumin than did the survivors (27.0 ± 1.6 g/L vs 34.0 ± 0.5 g/L, p = 0.0001). Patients on PD had a higher TLC than those on HD ( p = 0.0001). Conclusions In the HD population, but not in the PD population, both serum albumin and TLC were significantly higher in the group that survived. Serum albumin is a more powerful discriminator of mortality in the HD population, while TLC is a better discriminator of mortality in the PD population. For uncertain reasons, PD patients have a higher TLC than those on HD.

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Serum Albumin Level at Admission: Mortality and Clinical Outcome in Geriatric Patients

Cited by 13 publications

References 17 publications

Predictors of In-Hospital Mortality Among Older Patients

Predictors of In-Hospital Mortality Among Older Patients

Functional measures, inflammatory markers and endothelin-1 as predictors of 360-day survival in centenarians

Total Lymphocyte Count: A Promising Prognostic Index of Mortality in Patients on CAPD

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