Relationship of nutritional status, inflammation, and serum albumin levels during acute illness: A prospective study.

Eckart, Andreas; Struja, Tristan; Kutz, Alexander; Baumgartner, Annic; Baumgartner, Thomas; Zurfluh, Seline; Neeser, Olivia; Huber, Andreas; Stanga, Zeno; Mueller, Beat; Schuetz, Philipp (2020). Relationship of nutritional status, inflammation, and serum albumin levels during acute illness: A prospective study. The American journal of medicine, 133(6), 713-722.e7. Elsevier 10.1016/j.amjmed.2019.10.031

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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 (NRS 2002) as markers of inflammation and poor nutritional status, respectively, with low serum albumin levels and mortality using multivariate regression analyses.

RESULTS

Of 2,465 patients, 1,019 (41%) had low serum albumin levels (<34 g/L), 619 (25.1%) had increased nutritional risk (NRS 2002 ≥3), and 1,086 (44.1%) had CRP values >20mg/L. Multivariate analyses adjusted for age, gender, diagnosis, and comorbidities revealed elevated CRP values (adjusted odds ratio [OR] 10.51, 95% confidence intervals [CI] 7.51 to 14.72, P<0.001) and increased malnutrition risk (adjusted OR 2.87, 95% CI 1.98 to 4.15, P<0.001) 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 (AUCs) of 0.77, 0.70, and 0.75, respectively. Combination of these three parameters showed an AUC of 0.82 to predict mortality.

CONCLUSIONS

Elevated parameters of inflammation and high nutritional risk were independently associated with hypoalbuminemia. All three parameters independently predicted mortality. Combining them during initial evaluation of patients in emergency departments facilitates mortality risk stratification.

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