Department of Internal Medicine "F", Assaf Harofeh Medical Center (affiliated to Sackler School of Medicine, Tel Aviv University), Zerifin, Israel.
Eur J Intern Med. 2013 Dec;24(8):772-8. doi: 10.1016/j.ejim.2013.08.004. Epub 2013 Sep 4.
The prognostic significance of hypoalbuminemia and the dynamic changes in serum albumin during hospitalization in internal medicine wards has not been sufficiently investigated.
Demographic, clinical and laboratory data were collected from 276 patients admitted to our internal medicine ward for a variety of acute disorders. Following discharge, all-cause mortality was recorded. These data were compared between patient groups, according to levels of albumin: hypoalbuminemia or normoalbuminemia (serum albumin <34 g/l and ≥ 34 g/l, respectively), on admission and discharge.
Hypoalbuminemia on admission and on discharge was found in 46% and 54% of patients, respectively. Anemia, renal dysfunction, malignant disease, hypocholesterolemia, lymphopenia and albuminuria were more prevalent in patients with hypoalbuminemia, compared to those with normoalbuminemia (p ≤ 0.03). During a median follow-up period of 23 months, 107 of 276 patients died. Mortality was significantly higher (p<0.001) in patients with hypoalbuminemia than normoalbuminemia on admission (52.0% vs. 27.5%) and on discharge (53.7% vs. 21.2%), including those admitted with normoalbuminemia and discharged with hypoalbuminemia (43.6%). Survival rate was higher for patients admitted with hypoalbuminemia and discharged with normoalbuminemia than for those remaining with hypoalbuminemia (82.4% vs. 42.8%, p=0.004). The level of albumin on discharge (each 10 g/l decrement) was the most powerful predictor of shortened survival (relative risk 2.79, 95% confidence interval 2.04-3.70).
Hypoalbuminemia on admission, as well as persistence or development of hypoalbuminemia throughout hospitalization, was associated with poor prognosis. Treatment aimed at increasing low albumin or maintaining its normal level may improve survival.
内科病房患者低白蛋白血症的预后意义以及住院期间血清白蛋白的动态变化尚未得到充分研究。
从入住我院内科病房治疗各种急性疾病的 276 名患者中收集人口统计学、临床和实验室数据。出院后记录全因死亡率。根据白蛋白水平（入院时和出院时血清白蛋白<34 g/l 和≥34 g/l）将患者分为两组，并比较两组患者数据。
入院时和出院时低白蛋白血症的发生率分别为 46%和 54%。与白蛋白正常组相比，低白蛋白血症组更常见贫血、肾功能不全、恶性肿瘤、低胆固醇血症、淋巴细胞减少和白蛋白尿（p≤0.03）。中位随访 23 个月期间，276 名患者中有 107 人死亡。与白蛋白正常组相比，入院时和出院时均为低白蛋白血症的患者死亡率显著更高（p<0.001），分别为 52.0%和 27.5%，以及入院时白蛋白正常但出院时为低白蛋白血症的患者（43.6%）。入院时为低白蛋白血症但出院时为白蛋白正常的患者生存率高于持续为低白蛋白血症的患者（82.4%和 42.8%，p=0.004）。出院时白蛋白水平（每降低 10 g/l）是预测生存期缩短的最强指标（相对风险 2.79，95%置信区间 2.04-3.70）。
入院时低白蛋白血症，以及住院期间持续或发展为低白蛋白血症，与预后不良相关。治疗旨在提高低白蛋白血症或维持其正常水平可能改善生存率。
