Geriatric Research Education and Clinical Center, Central Arkansas Veterans Healthcare System, Little Rock, AR 72205, USA.
J Nutr Health Aging. 2011 Apr;15(4):311-5. doi: 10.1007/s12603-010-0297-1.
To examine the interrelationships among low serum albumin, nutritional depletion, and ongoing inflammation in older patients recovering from illness.
A prospective cohort study.
A transitional care unit (TCU) within a Department of Veterans Affairs hospital nursing home care unit.
275 older veterans (mean age=78.9 ± 7.5y, 99% male) admitted for recuperative care and rehabilitation.
At admission and discharge (median LOS 24d, IQR 16 to 44d), each subject completed a comprehensive standardized evaluation including a nutritional assessment and measurement of serum albumin, C-reactive protein (CRP), interleukin-6 (IL-6) and its soluble receptor, and tumor necrosis factor-alpha (TNF-α) and its soluble receptors (sTNF-RI and II). Complete nutrient intake assessments (calorie counts) were performed daily.
Both the discharge albumin and the change in albumin (discharge minus admission) were strongly and inversely correlated with various indicators of inflammation, particularly CRP and IL-6. Change in CRP was the strongest correlate of change in albumin (R2 = 0.21, P<.001) and discharge IL-6 the strongest correlate of discharge albumin (R2 = 0.21, P<.001). Nutrient intake also correlated with albumin and its change, but entered the multivariable models after inflammatory indicators and explained a smaller portion of the variance. Although there were significant interactions between time and both nutrient intake and inflammation, the relative importance of inflammation as a potential determinant of the serum albumin concentration appeared to remain unchanged with longer periods of observation.
Among elderly patients admitted to a TCU, inflammation appears to be a more powerful determinant of albumin and its change during the hospitalization than is nutrient intake. Further study is needed to prove causality and to determine whether the relative importance of inflammation on the albumin concentration diminishes with more prolonged periods of observation.
探讨老年患者在疾病康复过程中血清白蛋白降低、营养消耗和持续炎症之间的相互关系。
前瞻性队列研究。
退伍军人事务部医院疗养院的过渡护理病房（TCU）。
275 名老年退伍军人（平均年龄=78.9±7.5 岁，99%为男性），因康复和康复治疗入院。
入院和出院时（中位数 LOS 24d，IQR 16 至 44d），每位患者均完成了全面的标准化评估，包括营养评估以及血清白蛋白、C 反应蛋白（CRP）、白细胞介素-6（IL-6）及其可溶性受体、肿瘤坏死因子-α（TNF-α）及其可溶性受体（sTNF-RI 和 II）的测量。每天进行完整的营养素摄入量评估（卡路里计数）。
出院时白蛋白和白蛋白变化（出院时减去入院时）与各种炎症指标呈强烈负相关，尤其是 CRP 和 IL-6。CRP 的变化与白蛋白的变化相关性最强（R2=0.21，P<.001），而出院时 IL-6 与出院时白蛋白的相关性最强（R2=0.21，P<.001）。营养素摄入也与白蛋白及其变化相关，但在炎症指标之后进入多变量模型，解释的方差较小。尽管时间与营养摄入和炎症之间存在显著相互作用，但随着观察时间的延长，炎症作为血清白蛋白浓度潜在决定因素的相对重要性似乎保持不变。
在入住 TCU 的老年患者中，炎症似乎比营养素摄入更能决定白蛋白及其在住院期间的变化。需要进一步研究以证明因果关系，并确定炎症对白蛋白浓度的相对重要性是否会随着观察时间的延长而降低。
