Ryder Trauma Center, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
Massachusetts General Hospital, Department of Surgery, Division of Trauma, Emergency Surgery, and Surgical Critical Care, Boston, Massachusetts, USA.
Nutr Clin Pract. 2018 Jun;33(3):419-425. doi: 10.1002/ncp.10087. Epub 2018 Apr 17.
Serum albumin and prealbumin levels, may be more strongly associated with inflammation than with nutrient delivery. Their predictive value has not been extensively described in surgical intensive care unit (ICU) patients.
We analyzed a registry of adult surgical ICU patients receiving enteral nutrition. Subjects with at least 1 serum albumin, prealbumin, or C-reactive protein (CRP) level were included. Demographic, nutrition, and clinical outcome data were collected.
A total 252 subjects were included. A subset had serial measurements: albumin (n = 194), prealbumin (n = 13), CRP (n = 9), white blood cell (WBC) (n = 131), and neutrophil-lymphocyte ratio (NLR) (n = 86). Serum albumin level was inversely correlated with all 3 inflammatory biomarkers (CRP, ρ = -0.24, P <0.02; WBC, ρ = -0.15, P <0.001; and NLR, ρ = -0.26, P < 0.001). Change in serum albumin level was inversely correlated with change in NLR (ρ = -0.22, P = 0.044) but not with CRP or WBC. Admission serum albumin level was significantly higher in nourished vs. moderately and/or severely malnourished patients (3.2 [2.7-3.7] vs. 2.7 [2.3-3.0], P = 0.004). Admission serum prealbumin level was significantly higher in nourished vs. moderately and/or severely malnourished patients (9 [7-12] vs. 4 [3-5], P = 0.001). Serum albumin level was inversely correlated with Charlson Comorbidity Index (ρ = 0.20, P = 0.001). Calorie and/or protein delivery in the ICU was not correlated with changes in serum albumin or prealbumin levels.
In the ICU, initial serum albumin levels and serial trends are inversely correlated with inflammation. Although initial serum albumin levels are reflective of baseline nutrition status, neither serum albumin level nor serum prealbumin level trends correlate with calorie or protein deficits and should not be used to assess adequacy of nutrition delivery.
血清白蛋白和前白蛋白水平可能与炎症的相关性强于与营养输送的相关性。在外科重症监护病房（ICU）患者中，尚未广泛描述它们的预测价值。
我们分析了接受肠内营养的成年外科 ICU 患者的登记数据。纳入至少有 1 次血清白蛋白、前白蛋白或 C 反应蛋白（CRP）水平检测的患者。收集了人口统计学、营养和临床结局数据。
共纳入 252 例患者。部分患者有连续测量值：白蛋白（n=194）、前白蛋白（n=13）、CRP（n=9）、白细胞（WBC）（n=131）和中性粒细胞-淋巴细胞比值（NLR）（n=86）。血清白蛋白水平与所有 3 种炎症标志物呈负相关（CRP，ρ=-0.24，P<0.02；WBC，ρ=-0.15，P<0.001；NLR，ρ=-0.26，P<0.001）。血清白蛋白水平的变化与 NLR 的变化呈负相关（ρ=-0.22，P=0.044），但与 CRP 或 WBC 无关。营养良好的患者与中度和/或重度营养不良的患者相比，入院时血清白蛋白水平显著更高（3.2[2.7-3.7] vs. 2.7[2.3-3.0]，P=0.004）。营养良好的患者与中度和/或重度营养不良的患者相比，入院时血清前白蛋白水平显著更高（9[7-12] vs. 4[3-5]，P=0.001）。血清白蛋白水平与 Charlson 合并症指数呈负相关（ρ=0.20，P=0.001）。ICU 中的热量和/或蛋白质输送与血清白蛋白或前白蛋白水平的变化无相关性。
在 ICU 中，初始血清白蛋白水平和连续趋势与炎症呈负相关。虽然初始血清白蛋白水平反映了基线营养状况，但血清白蛋白水平和前白蛋白水平的趋势均与热量或蛋白质不足无关，不应用于评估营养输送的充足性。
