Serum Prealbumin: a potential predictor of Right Ventricular Dysfunction in patients receiving programmed hemodialysis

Abstract

OBJECTIVE: Prealbumin has been a reliable marker to predict protein energy malnutrition and hypercatabolic state. In this analysis, we particularly aimed to investigate the potential association between serum prealbumin levels and right ventricular dysfunction in patients receiving programmed hemodialysis. METHODS: A total of 57 subjects were included in the analysis. The subjects were then categorized into two groups: right ventricular dysfunction (n=18) and non-right ventricular dysfunction (n=39) groups. In all patients, detailed transthoracic echocardiography (following hemodialysis) were performed along with the evaluation of complete blood count, routine biochemistry parameters, and, in particular, serum prealbumin levels. RESULTS: Mortality rate at 3 years was found to be significantly higher in the right ventricular dysfunction group (p=0.042). Serum prealbumin levels were also significantly lower in the right ventricular dysfunction group compared with the non-right ventricular dysfunction group (23.83±8.50 mg/dL versus 31.38±6.81 mg/dL, p=0.001). In the receiver operating characteristics curve analysis, a prealbumin cutoff value of <28.5 mg/dL was found to predict right ventricular dysfunction, with a sensitivity of 67% and a specificity of 62% (area under the curve: 0.744). In the correlation analysis, a moderate yet significant positive correlation was demonstrated between serum prealbumin and tricuspid annular plane systolic excursion (r=0.365, p=0.005). CONCLUSION: This study suggests that low serum prealbumin might serve as a potential predictor of right ventricular dysfunction (and its clinical consequences) in patients receiving programmed hemodialysis.

Association of prealbumin with short-term and long-term outcomes in patients with acute ST-segment elevation myocardial infarction

“…In addition to the above-mentioned findings, the predictive value of prealbumin for cardiac disease has also been reported. Investigators have demonstrated strong relationships between low prealbumin and angiographic severity, [8] in-hospital MACE [30] in ACS patients, poor outcome in acute HF patients, [31,32] and right ventricular dysfunction in hemodialysis patients. [33] In agreement with Wang, et al [30] our results showed that low prealbumin was independently correlated with increased inhospital MACE in patient with STEMI.…”

Comment on “Serum prealbumin: a potential predictor of right ventricular dysfunction in patients receiving programmed hemodialysis”

“…First, as described in Table 1 of that study 1 , C-reactive protein (CRP) was higher in patients with RVD compared with patients without RVD [1.45 (0.95–3.30) versus 0.80 (0.40–1.60), p=0.023], suggesting that both prealbumin and CRP concentrations had a significant difference in patients with and without RVD. In this case, either lower prealbumin or elevated CRP concentrations may be associated with poorer right ventricular function, and it cannot be roughly assumed that lower right ventricular function is only associated with lower prealbumin, ignoring the role of CRP.…”

“…We read with great interest a recent study 1 investigating the relationship between serum prealbumin concentration and right ventricular dysfunction (RVD) in patients undergoing programmed hemodialysis. In this study 1 , the results found that patients with RVD had lower prealbumin concentration compared with patients without RVD (23.83±8.50 mg/dL versus 31.38±6.81 mg/dL, p=0.001), and prealbumin concentration had an important role in predicting RVD. However, after reading this study carefully, we think that the following questions deserve further clarification.…”