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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Endocrinology, Diabetology and Clinical Nutrition

UniBE Contributor:

Stanga-Nodari, Zeno

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1555-7162

Publisher:

Elsevier

Language:

English

Submitter:

Regula Maria Schneider

Date Deposited:

23 Jan 2020 13:55

Last Modified:

15 Jun 2020 01:31

Publisher DOI:

10.1016/j.amjmed.2019.10.031

PubMed ID:

31751531

Uncontrolled Keywords:

Nutritional risk inflammation mortality serum albumin

BORIS DOI:

10.7892/boris.138397

URI:

https://boris.unibe.ch/id/eprint/138397

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