Predictors of Clinical Outcome

The best marker of injury is serum albumin concentration. It is an excellent predictor of survival in patients with cancer and other types of illnesses (Table 6). More than 20 studies have shown that a serum albumin level below normal can be used to predict disease outcomes in many groups of patients. One of the first studies in this area was a Veterans Administration study in which 30-day mortality rates were evaluated for a total of 2060 consecutive medical and surgical admissions. Investigators found that 24.7% of the patient population had a low albumin level defined as 3.4g/dl or lower. The 30-day mortality rate for hypoalbuminemia patients was 24.6% compared to 1.7% for patients with a normal albumin level. These investigators demonstrated an excellent correlation between serum albumin levels and 30-day mortality rates. A 1-g decrease in serum albumin levels (3.5 to 2.5g/dl) translated into a 33% increase in mortality. Patients with an average albumin level of 1.8 g/dl had a mortality rate of 65%. It is interesting to note that of 15 hypoalbuminemia patients in this study who were provided with total parenteral nutrition, only 1 died (7% mortality).

Protein malnutrition is associated with a greater risk for infection, especially fungal infections. In one

Table 6 Serum albumin and mortality

Patient population Mortality

With normal albumin With low albumin (%) Increased risk (-fold) Albumin cutoff level (g/dl)

n %

VA hospital

2060

1.7

24.7

14.7

3.5

Medical and surgical patients

500

1.3

7.9

6.1

3.5

Hodgkins

586

1.0

10

10.0

3.5

Lung CA

59

49

85

1.7

3.4

VA hospital

152

3.3

25.8

7.8

3.5

Surgical patients

243

4.7

23

4.9

3.5

Malnutrition

92

8.0

40

5.0

3.5

Surgery (colorectal)

83

3.0

28

9.3

3.5

ETOH hepatitis

352

2.0

19.8

9.9

3.5

Pneumonia

38

0

100

3.0

Cirrhosis

139

32

52

1.6

2.9

ICU patients

55

10

76

7.6

3.0

Cardiovascular disease

7735

0.0

2.0

4.0

Trauma

34

15.4

28.6

1.9

3.5

Sepsis

199

0.7

15.9

22.7

2.9

Pneumonia

456

2.1

8.3

4.0

3.5

Multiple meyloma

23

25

50

2.0

3.0

CABG/cardiac valve surgery

5156

0.2

0.9

5.7

2.5

Preoperative (VA hospital)

54 215

2.0

10.3

5.1

3.5

Beth Israel Hospital

15511

4.0

14.0

3.5

3.4

Hemodialysis

13 473

8.0

16.6

2.1

4.0

Average ± SEM

4275

7.8 i 2.8

31 i 7

15 i 2-fold risk

3.4 i 0.1

Total No. of patients

101 178

study, the most important risk factor for the development of candidemia was malnutrition. A reduced serum albumin level is an independent risk factor for nosocomial infections. The greater the protein malnutrition, the greater the risk for nosocomial infections.

In summary, serum albumin concentrations provide the clinician with a tool to help predict recovery or mortality. Albumin levels should be monitored at regular intervals (every 3 or 4 days) for hospitalized patients who are ill and at risk for malnutrition. Once hypoalbuminemia is documented, it is not an ideal indicator of nutritional rehabilitation since it returns to normal slowly (21-day half-life) and lags behind other indices of nutritional status, such as transferrin (7-day half-life), prealbumin (1-day half-life), or retinol binding protein (4-h half-life). Albumin replacement does not reverse the metabolic process that the hypoalbuminemia state represents. The reduced level of protein reserves in the patient and the severity of the metabolic injury or cancer are the two most important determinants of serum albumin level.

Was this article helpful?

0 0
10 Ways To Fight Off Cancer

10 Ways To Fight Off Cancer

Learning About 10 Ways Fight Off Cancer Can Have Amazing Benefits For Your Life The Best Tips On How To Keep This Killer At Bay Discovering that you or a loved one has cancer can be utterly terrifying. All the same, once you comprehend the causes of cancer and learn how to reverse those causes, you or your loved one may have more than a fighting chance of beating out cancer.

Get My Free Ebook


Post a comment