The association between prealbumin, all-cause mortality and response to nutritional treatment in patients at nutritional risk. Secondary analysis of a randomized-controlled trial.

Bretscher, Céline; Buergin, Michelle; Gurzeler, Gianna; Kägi-Braun, Nina; Gressies, Carla; Tribolet, Pascal; Lobo, Dileep N; Evans, David C; Stanga, Zeno; Mueller, Beat; Schuetz, Philipp (2023). The association between prealbumin, all-cause mortality and response to nutritional treatment in patients at nutritional risk. Secondary analysis of a randomized-controlled trial. Journal of parenteral and enteral nutrition (JPEN), 47(3), pp. 408-419. Wiley 10.1002/jpen.2470

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INTRODUCTION

Due to the shorter half-life as compared with albumin, serum prealbumin concentrations have been proposed to be useful nutritional biomarkers for the assessment of patients at nutritional risk. In a post-hoc analysis of patients at nutritional risk from a randomized-controlled nutritional trial, we therefore tested the hypothesis that (a) prealbumin is associated with higher all-cause 180-day mortality rates and that (b) individualized nutritional support compared to usual care nutrition more effectively improves survival at 30 days in patients with low prealbumin levels compared to patients with normal prealbumin levels.

METHODS

We performed a pre-specified cohort study in patients included in the pragmatic, Swiss, multicenter, randomized-controlled EFFORT trial comparing the effects of individualized nutritional support with usual care. We studied low prealbumin concentrations (<0.17 g/l) in a subgroup of 517 patients from one participating centre.

RESULTS

A total of 306 (59.2%) patients (mean age 71.9 years, 53.6% men) had low admission prealbumin levels (<0.17 g/L). There was a significant association between low prealbumin levels and mortality at 180-days [115/306 (37.6%) vs. 47/211 (22.3%), fully adjusted hazard ratio (HR) 1.59, 95%CI 1.11 to 2.28, p=0.011]. Prealbumin levels significantly improved the prognostic value of the Nutritional Risk Screening total score regarding mortality prediction at short- and long-term. The difference in mortality between patients receiving individualized nutritional support and usual care nutrition was similar for patients with low prealbumin levels compared with patients with normal prealbumin levels [HR 0.90 (95%CI 0.51 to 1.59) vs. HR 0.88 (95%CI 0.35 to 2.23)] with no evidence for interaction (p=0.823).

CONCLUSION

Among medical inpatients at nutritional risk, low admission prealbumin levels correlated with different nutritional markers and higher mortality risk; but patients with low or high prealbumin levels had a similar benefit from nutritional support. Further studies should identify nutritional markers that help further personalize nutritional interventions.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02517476 This article is protected by copyright. All rights reserved.

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