Relationship of Nutritional Status, Inflammation, and Serum Albumin Levels During Acute Illness: A Prospective Study - 19/06/20
, Tristan Struja, MD a, b, Alexander Kutz, MD a, Annic Baumgartner, MD a, b, Thomas Baumgartner a, 1, Seline Zurfluh, MD a, Olivia Neeser a, Andreas Huber, MD c : Prof, Zeno Stanga, MD d : Prof, Beat Mueller, MD b, e : Prof, Philipp Schuetz, MD, MPH a, e : ProfAbstract |
Background |
Low serum albumin levels resulting from inflammation-induced capillary leakage or disease-related anorexia during acute illness are associated with poor outcomes. We investigated the relationship of nutritional status and inflammation with low serum albumin levels and 30-day mortality in a large cohort.
Methods |
We prospectively enrolled adult patients in the medical emergency department of a Swiss tertiary care center and investigated associations of C-reactive protein (CRP) and Nutritional Risk Screening 2002 as markers of inflammation and poor nutritional status, respectively, with low serum albumin levels and mortality using multivariate regression analyses.
Results |
Among the 2465 patients, 1019 (41%) had low serum albumin levels (<34 g/L), 619 (25.1%) had increased nutritional risk (Nutritional Risk Screening 2002 ≥3), and 1086 (44.1%) had CRP values >20 mg/L. Multivariate analyses adjusted for age, gender, diagnosis, and comorbidities revealed elevated CRP values (adjusted odds ratio [OR] 10.51, 95% confidence interval, 7.51-14.72, P <.001) and increased malnutrition risk (adjusted OR 2.87, 95% confidence interval, 1.98-4.15, P <.001) to be associated with low serum albumin levels, even adjusting for both parameters. Low serum albumin levels, elevated CRP values, and increased nutritional risk independently predicted 30-day mortality, with areas under the curve of 0.77, 0.70, and 0.75, respectively. Combination of these 3 parameters showed an area under the curve of 0.82 to predict mortality.
Conclusions |
Elevated parameters of inflammation and high nutritional risk were independently associated with hypoalbuminemia. All 3 parameters independently predicted mortality. Combining them during initial evaluation of patients in emergency departments facilitates mortality risk stratification.
Le texte complet de cet article est disponible en PDF.Keywords : Inflammation, Mortality, Nutritional risk, Serum albumin
Plan
| Funding: ThermoFisher provided an unrestricted research grant for the TRIAGE study. PS is supported by the Swiss National Science Foundation (SNSF Professorship, PP00P3_150531/1) and the Research Council of the Kantonsspital Aarau (1410.000.044). |
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| Role of the Funder/Sponsor: The funders/sponsors had no role in the design or conduct of the study; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. |
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| Conflict of Interest: AK, BM, and PS received support from B•R•A•H•M•S AG (now ThermoFisher Scientific Biomarkers) and bioMérieux for meetings, speaking engagements, and research grants. BM has served as a consultant to both companies. |
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| Authorship: All authors had access to the data and a role in writing this manuscript. AE and PS had complete access to all study data and take full responsibility for the integrity of the data and the accuracy of the analyses. All authors made substantive intellectual contributions to this study regarding conception and design of the study, and were responsible for the acquisition, analysis, and interpretation of the data. AE, TS and PS performed the statistical analyses and drafted the first manuscript. All authors approved the final version of the manuscript and the decision to submit the manuscript for publication. |
Vol 133 - N° 6
P. 713 - juin 2020 Retour au numéro
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